- CVS Health (Hartford, CT)
- …based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff *… more
- Centene Corporation (Jefferson City, MO)
- …improvement activities. + Develop and have oversight of training and expertise for Medicare appeals reviews, ALJ hearings. Have oversight of STARS metrics ... NCD's, LCD's, final rules, STARS metrics) and previous experience leading Medicare Appeals , IRE and ALJ hearings, STARS metrics + Previous experience with… more
- CVS Health (Columbus, OH)
- …role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. **Key Responsibilities** + Requesting ... And we do it all with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this… more
- Humana (Lincoln, NE)
- …us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
- CenterWell (Denver, CO)
- …and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...direction and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS… more
- Molina Healthcare (Bothell, WA)
- …benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive… more
- NTT America, Inc. (Plano, TX)
- …Senior Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end ... delivery of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end… more
- Guidehouse (El Segundo, CA)
- …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 client and… more
- US Tech Solutions (RI)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
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