- 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 ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement ...new CPT and HCPCS codes for coding logic, related Medicare / Medicaid policies to make recommend reimbursement… more
- Guidehouse (El Segundo, CA)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... You Will Do** **:** The **Insurance Patient Account Representative** **(Hospital Claims )** is an extension of a client's business office staff. Representatives… more
- Prime Healthcare (Redding, CA)
- …family. For more information, visit www.shastaregional.com. Responsibilities The Senior Medicare - Medicaid Biller/Collector is responsible for both billing and ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Manager, Medicare Claims , oversees end-to-end claims services for provider segments, meeting business goals. This role sets ... will result in improved customer satisfaction. + Serve as Medicare Claims Subject Matter Expert and single...in related field. **Bonus Points** + 1-2 years of Medicare and Medicaid experience or a highly… more
- Humana (Columbia, SC)
- …The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, ... Business Intelligence Engineer will be responsible for: Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities Developing… more
- Humana (Boise, ID)
- …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
- Highmark Health (Buffalo, NY)
- …interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to ... of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is...is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue… more
- Robert Half Accountemps (Fort Wayne, IN)
- …role involves managing Medicare , Medicaid , and commercial insurance claims with precision and compliance, ensuring timely reimbursement and efficient ... on performance and organizational needs. Responsibilities: * Prepare and submit accurate claims to Medicare , Medicaid , and third-party insurance providers,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment,… more
- Hartford HealthCare (Farmington, CT)
- …timely and accurate collection of third-party payers, resolving outstanding insurance claims across all Hartford HealthCare hospitals, medical group and homecare. ... Provides input on decisions that affect workflows effecting timely resolution of insurance claims . 4. Provides support for other ad hoc analyses and projects as… more