- Granville Health System (Oxford, NC)
- …for Medicaid or other account needs to correct patient outstanding balances Review all Medicare and Medicaid overpayments creating credit balances and ... accounts as they are processed by insurance.# Logs all Medicare crossover bad debts on the appropriate logs.# Works...Medicaid on the appropriate bad debt logs for processing Review and process returned mail by searching for updated… more
- Granville Medical Center (Oxford, NC)
- …for Medicaid or other account needs to correct patient outstanding balances Review all Medicare and Medicaid overpayments creating credit balances and ... accounts as they are processed by insurance. Logs all Medicare crossover bad debts on the appropriate logs. Works...Medicaid on the appropriate bad debt logs for processing Review and process returned mail by searching for updated… more
- Centene Corporation (Jefferson City, MO)
- …cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and ... education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of medical services,… more
- Centene Corporation (Jefferson City, MO)
- …ensures they are addressed timely through established paths and processes. + Conducts review of evidence to address root cause of issue and facilitate timely closure ... of issues. + Develops, implements and continually refines corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions. + Supports management… more
- Trinity Health (Davenport, IA)
- …Families, and Significant Others, Vendors/Clients, Third Party Payors/Insurance Companies, Auditors/ Review Agencies + The job requires some accountability for ... scheduling, assigning or coordinating work. Employees check the quality of work and provide guidance, instruction, training and direction to others. Although the job does not require formal or official supervisory responsibility, the incumbent serves as group… more
- Houston Methodist (Houston, TX)
- …+ Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care ... At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered...Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON),… more
- HCA Healthcare (Campbell, CA)
- …visits, phone meetings and/or assistance with completing program requirements. + Medicare Reimbursement: HCC (50%) Review and process/document all supplemental ... Improvement Specialist** is to help manage the quality improvement initiatives and Medicare reimbursement programs. In addition to adhering to set project deadlines,… more
- Cognizant (Minot, ND)
- …to detail **Preferred Qualifications** + Medical/Health Insurance knowledge + Medicare background **Responsibilities:** + Review orders, summarize medical ... of the Pre-Authorization Specialist is to verify benefit eligibility, review /summarize orders, acquire prior authorization(s) and partner with respective Sales… more
- Molina Healthcare (New York, NY)
- …unrestricted State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review , medical policy/procedure development, ... quality and financial goals across all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the BH MD lead trainers in the… more
- WMCHealth (Poughkeepsie, NY)
- …party billing companies, Medicare and Medicaid, as well as insurance denial review as appropriate. + Ability to multi-task in a fast and high pressure ... Facility Billing, Insurance Verifications, Third Party Insurance coverage, Medicaid and Medicare eligibility, Insurance denial review and overturn procedures. +… more