• Detroit Recovery Project (Detroit, MI)
    …(Diagnoses) codes and CPT codes Excellent knowledge of insurance companies (HMO, BCBSM, Medicaid , Medicare etc.) and insurance claims requirements Excellent ... credit extended to patients, and filing, collecting, and expediting third-party claims . Maintain business office inventory and equipment by checking stock to… more
    Upward (07/02/25)
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  • Medicare / Medicaid Claims…

    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
    Commonwealth Care Alliance (05/28/25)
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  • Sr Medicaid Reimbursement Regulatory…

    Zelis (Plano, TX)
    …good understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing , contracting, preferred-provider ... personal interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer… more
    Zelis (07/12/25)
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  • Claims Processing Rep - On-site

    Central Maine Medical Center (Lewiston, ME)
    …and medical terminology * Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid . What It's Like Working At CMH: We are ... Wellness Program + Essential Duties: Review claims using electronic claims software -compliance products, editing and transmitting. 2. Completes processing… more
    Central Maine Medical Center (07/03/25)
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  • Senior Clinical Review Nurse - Correspondence

    Centene Corporation (Phoenix, AZ)
    …in Nursing and 4 - 6 years of related experience. Expert of Medicare and Medicaid regulations preferred. Expert of utilization management processes preferred. ... + Performs clinical review of outcomes including creating and editing denial letters with the correspondence team based on...coding issues and provides supplemental information to resolve denial claims + Acts as a point of contact for… more
    Centene Corporation (07/19/25)
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