- LA Care Health Plan (Los Angeles, CA)
- …This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care ... and provider complaint and appeals issues, including eligibility, access to care, claims , benefit, and quality of care concerns. Experience working with firm… more
- Excelsior Orthopaedics Group (Amherst, NY)
- …(eg Medent, Epic, or similar) is required. + Comprehensive knowledge of commercial, Medicare , Medicaid , and workers' comp billing procedures preferred. + Strong ... services. This role is responsible for follow-up and resolution to optimize reimbursement from insurance carriers and patients on a timely basis. The Billing… more
- Stony Brook University (East Setauket, NY)
- …variances and denials. + Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies. + Expert knowledge of third ... limited to:** + Develops staff work listing logic/strategy and claims resolution work flows. + Educates and trains new...+ Assists in maintaining and creating payer report cards, claims tracking and management reporting as requested. + Assists… more
- Takeda Pharmaceuticals (Cambridge, MA)
- …pharmacy and distributor agreements, including agreements with: commercial and Medicare payers, pharmacy benefit managers (PBMs), Oncology GPOs, the Department ... of Veterans Affairs (VA), Federal Supply Schedule (FSS), Medicaid , the Department of Defense (DOD), specialty pharmacies and...and device companies, including the Antikickback Statute, the False Claims Act (FCA), the Food, Drug & Cosmetic Act… more
- Ascendis Pharma (Princeton, NJ)
- …government programs + Deep expertise in US Federal and State Pricing Programs ( Medicaid , Medicare , VA/DoD, PHS/340B) and related regulations. + Expertise in GP ... deep understanding of US government pricing programs, and the pharmaceutical reimbursement landscape. Key Responsibilities + Lead the end-to-end government pricing… more
- Hackensack Meridian Health (Neptune City, NJ)
- …problems and initiate correction if applicable. Work to resolve billing issues with Medicare , Medicaid and insurance companies. Follow up to ensure corrections ... including comprehensive Health Benefits, generous Paid Time Off, Travel Reimbursement as well as an investment in your future...and complete prior to due date to reduce held claims for billing. + Process all reauthorization requests to… more
- Trinity Health (Westchester, IL)
- …communication with patients, third-party payers, and insurance companies (including Medicare / Medicaid ) to resolve outstanding balances, investigate claim ... Case Management, and Managed Care to gather necessary information and ensure claims are processed efficiently. **Key Responsibilities:** + Proactively follow up on… more
- Commonwealth Care Alliance (Boston, MA)
- …Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare / Medicaid ) + Experience in health plan provider relations + Experience ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
- Commonwealth Care Alliance (Boston, MA)
- …experience + Experience in health plan provider relations. **Experience (Desired)** + Medicare / Medicaid experience preferred. + Experience with CPT coding and ... with key providers; orient providers on CCA's policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization;… more
- US Tech Solutions (Monroeville, PA)
- …I will be responsible for qualifying, preparing and submitting claims to Medicare Part B, Major Medical and Medicaid . Individual must work with LTC ... document images, collect supporting or additional information on fills and work claims through to resolution to ensure compliant, timely and accurate billing… more