- 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
- 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
- Healthfirst (NY)
- …and identify published updates to payment methodologies, fee schedules and claims editing policies from Medicare , Medicaid , and third-party sources. + ... the on-going audit of configurations for new and existing claims business rules within the claims processing...MHS and/or MACESS systems a plus. + Knowledge of Medicare and Medicaid programs and reimbursement methodologies… more
- 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
- Healthfirst (NY)
- …analysis + Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid , Family Health Plus, Child Health Plus, NH Family + Experience ... service appeals utilizing appropriate sources of information; including eligibility, claims , authorizations, service forms, faxes, and any additional information… more
- Humana (Des Moines, IA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more