- AdventHealth (Orlando, FL)
- …record, applying appropriate ICD-10-CM/PCS coding conventions and MS-DRG Medicare Prospective Payment System requirements. Actively participates in outstanding ... ICD-10-CM rules and conventions, coding policy and procedures, requirements of Medicare / payer specifications, and official coding guidelines as outlined by… more
- Molina Healthcare (Rockford, IL)
- …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance contributes to one or ... and Quality Improvement Compliance. + Acts as a lead specialist to provide project-, program-, and / or initiative-related...Healthcare. **Preferred Experience** + 1 year of experience in Medicare and in Medicaid. + Experience with data reporting,… more
- AdventHealth (Altamonte Springs, FL)
- …- Benefits from Day One - Paid Days Off from Day One - 100% Remote ! **Our promise to you:** Joining AdventHealth is about being part of something bigger. It's ... medical record, applying appropriate ICD-10-CM/PCS coding conventions and MS-DRG Medicare Prospective Payment System requirements. Actively participates in outstanding… more
- Molina Healthcare (Omaha, NE)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Savannah, GA)
- …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/ QI Compliance contributes to one or ... Health or Healthcare. **Preferred Experience** 1 year of experience in Medicare and in Medicaid. **Preferred License, Certification, Association** + Certified… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Specialist , Quality Assurance I is responsible for examining and evaluating the accuracy of transactions in accordance ... programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Medicare /Medicaid Claims **Equal Employment Opportunity** CareFirst BlueCross BlueShield is… more
- Ochsner Health (Jefferson, LA)
- …surgeries/procedures and observation patients. Remains in conformance with applicable Medicare , Medicaid and third-party payer guidelines to ensure receipt of ... the job description to determine whether the position you are interested in is remote or on-site._** _Individuals who reside in and will work from the following… more
- Molina Healthcare (Columbus, GA)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Kearney, NE)
- …tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources ... to validate overpayments made to providers. * Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. * Enters and updates recovery applications and… more
- CareFirst (Baltimore, MD)
- …Administration. + Knowledge of healthcare or health insurance payor industry ( Medicare , Medicaid, Commercial, DSNP and other payor programs), including legal and ... regulatory requirements. + Solid understanding of CPT-4, HCPCS, revenue and ICD coding, medical terminology, claims payment, contract negotiations and problem resolution. **Knowledge, Skills and Abilities (KSAs)** + Understanding of multiple reimbursement… more