- Commonwealth Care Alliance (Boston, MA)
- …and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims ' processing policies, coding principals and ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Humana (Nashville, TN)
- …on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement/ editing logic and Humana system logic **Use your skills ... closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Northwell Health (Lake Success, NY)
- …and billing modules. + Understanding of payer guidelines and regulations (eg, Medicare , Medicaid , commercial payers). + Exceptional attention to detail and ... of project plans and evaluates outcomes. This role is instrumental in ensuring claims are accurately prepared and edited within Epic before submission to payers,… more
- UPMC (Pittsburgh, PA)
- …clinical coding edits. Your insights will help us ensure compliance with Medicare , Medicaid , and other payor requirements while identifying opportunities for ... Analyst to play a critical role in shaping how claims are processed and paid. This is your opportunity...be the go-to expert for payment accuracy and claim editing . You'll work closely with our external software vendor… more
- Humana (San Juan, PR)
- …for researching, reviewing, and educating providers regarding disputes on adjudicated claims involving code editing denials or recoveries. The coordinator ... Coder + Demonstrate ability to problem-solve complex coding issues + Experience with Medicare and Medicaid coding guidelines + Strong data entry and attention… more
- Centene Corporation (Jefferson City, MO)
- …and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services. + Ensures Payment Integrity DRG Review ... with coding practices through a comprehensive review and analysis of medical claims , medical records, claims history, state regulations, contractual obligations,… more
- City and County of San Francisco (San Francisco, CA)
- … claims processing, and/or collecting healthcare service reimbursements or medical claims from Medi-Cal ( Medicaid ), Medicare , insurance, third party ... and tracking of issues; + Performs revenue analysis related to charge errors, claims submission volume, denials and trends based on claim type and/or payer,… more
- Humana (Charleston, WV)
- …Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The ... Demonstrate ability to problem-solve complex coding issues + Experience with Medicare and Medicaid coding guidelines + Strong data entry and attention to detail… more
- Humana (San Juan, PR)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS +… more
- Stanford Health Care (Palo Alto, CA)
- …payer rejections, denials, and performing appeals as necessary + Electronic or hardcopy claims editing and submission to payers + Recognizing potential trends ... and procedures and medical terminology + Knowledge of payer landscape, including Medicare , Medicaid , Workers' Compensation, Managed Care, or other Commercial… more