- Kelsey-Seybold Clinic (Cypress, TX)
- …patients to specialists and other healthcare providers. + Understands reimbursement criteria and Endocrinology billing/coding. + Performs specific duties delineated ... and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their ... and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- …and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their ... and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their… more
- Trinity Health (Livonia, MI)
- …code(s) by utilizing coding guidelines established by: + The Centers for Medicare /Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ... codes, modifiers, internal edits and claim edits that could impact hospital reimbursement . Interprets bundling and unbundling guidelines (NCCI edits) as well as… more
- RWJBarnabas Health (West Orange, NJ)
- …on legal matters involving managed care and payer contracting, value-based reimbursement models, and contract negotiation strategies. The successful candidate will ... and regulatory issues relating to payor relationships, third-party administrators, Medicare Advantage, and Medicaid Managed Care. This position requires at… more
- BrightSpring Health Services (Louisville, KY)
- …Dental, Vision, and Life Insurance + Company-Paid Disability Insurance + Tuition Assistance & Reimbursement + Employee Discount Program + 401k Plan + Paid Time Off + ... identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks + Researches, analyzes and… more
- WMCHealth (Valhalla, NY)
- …payment of their medical treatment and to determine the method of payment/ reimbursement to Westchester Medical Center. This involves coordination with other Medical ... including Blue Cross/Blue Shield, Workers' Compensation, private insurance carriers, Medicare and Medicaid to verify the patient's eligibility for coverage,… more
- Molina Healthcare (Warren, MI)
- …the Plan's membership. + Develops and maintains a market-specific provider reimbursement strategy consistent with Reimbursement Tolerance Parameters (across ... multiple specialties/geographies). Oversees the development of new reimbursement models. Obtains input from Corporate and Legal regarding new reimbursement … more
- Insight Global (Indianapolis, IN)
- …review of MAC adjustments. You will assist leadership by researching reimbursement scenarios, calculating impacts, and supporting settlement entries through the ... handle Medicaid DSH Eligibility and HSL surveys, contributing to compliance and reimbursement strategies. Prepare and review 2-3 hospital cost reports, including MAC… more
- Molina Healthcare (Layton, UT)
- …providers. Contract/Re-contracting with large scale entities involving custom reimbursement . Executes standardized Alternative Payment Method contracts. Issue ... attorney. * Participates in fee schedule determinations including development of new reimbursement models. Seeks input on new reimbursement models from Corporate… more