- R1 RCM (Chicago, IL)
- …billing, resolution, and revenue cycle management. **Key Responsibilities:** + Review outpatient hospital facility, clinic, and physician documentation, including, ... research and validate hospital reporting. + Build and maintain expertise in Medicare and Managed Care billing, coding, and reimbursement policies. + Support… more
- Molina Healthcare (Yakima, WA)
- …the product choices available to them, the enrollment process (eligibility requirements, Medicare review /approval of their enrollment application, timing of ID ... for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare -Medicaid recipients within approved… more
- The Cigna Group (Bloomfield, CT)
- …for Medicare Part D Health Plans: PDP, MAPD, and Special Needs Program (SNPs) + Review Medicare Part D Plan bid assumptions for Regulated Medicare Part D ... Health Plans + Create analytics for Medicare Part D Bids substantiation for Desk Review and Medicare Part D audits + Utilize independent judgement and… more
- US Tech Solutions (May, OK)
- …+ The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or ... As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related...ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach… more
- Commonwealth Care Alliance (Boston, MA)
- …research, as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review /approval through the Payment Integrity governance ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also...Optum CES and Zelis edits. + Quarterly and Annual review and research, as necessary on all new CPT… more
- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...review . + Knowledge of OASIS, Home Care and Medicare regulations + Excellent organizational, interpersonal and communication skills… more
- HCA Healthcare (Nashville, TN)
- …you find this opportunity compelling, we encourage you to apply for our Medicare Specialist opening. We promptly review all applications. Highly qualified ... individual is recognized. Submit your application for the opportunity below: Medicare SpecialistParallon **Benefits** Parallon, offers a total rewards package that… more
- Guidehouse (Lewisville, TX)
- …Antonio, TX offices and three days from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + ... Customer Service + Billing + UB-04 & CMS 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist… more
- Healthfirst (NY)
- …of business + Provide support for annual Medicare bids for all Healthfirst's Medicare products + Review and quantify any regulatory / CMS proposals and/or ... or any related degree + Experience in the actuarial field related to Medicare (bid development/ review , analysis, reporting, risk scores) + Ability to collect,… more
- AdventHealth (Glendale Heights, IL)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) + standards and communicates relevant coverage/eligibility… more