• Staffing Solutions Organization (Albany, NY)
    …update eligibility and claims systems. + Take the appropriate actions regarding Medicaid enrollment and premium reimbursement . + Understand the Medicare ... may be received from a variety of sources such as Centers for Medicare and Medicaid Services (CMS), Insurance Carriers, and others. + Ability to problem solve… more
    DirectEmployers Association (10/16/25)
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  • Stony Brook University (East Setauket, NY)
    …+ Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + ... support day-to-day business functions including but not limited to: billing, claims analysis appeals, follow-up, financial assistance and customer service. **Duties… more
    DirectEmployers Association (10/03/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …initiatives to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid - Medicare Plan withhold measures, quality ... CAHPS, HOS) and value-based contract performance metrics + Experience with Medicare Advantage, Medicaid ; and dually eligible populations **Desired Experience**… more
    DirectEmployers Association (10/29/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Required Knowledge, Skills & Abilities (must have): - Strong understanding of claims processing, reimbursement methodologies, and payment policies, with the ... their impact on provider operations and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …experience + Experience in health plan provider relations. **Experience (Desired)** + Medicare / Medicaid experience preferred. + Experience with CPT coding and ... with key providers; orient providers on CCA's policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization;… more
    DirectEmployers Association (10/18/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare / Medicaid ) + Experience in health plan provider relations + Experience ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
    DirectEmployers Association (10/17/25)
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  • Stanford Health Care (Palo Alto, CA)
    …and procedures and medical terminology + Knowledge of payer landscape, including Medicare , Medicaid , Workers' Compensation, Managed Care, or other Commercial ... is responsible for the timely and accurate processing of insurance balance patient claims in accordance with contracts and policies. The PAR works in various… more
    DirectEmployers Association (10/01/25)
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  • Medicare / Medicaid Claims…

    Commonwealth Care Alliance (Boston, MA)
    … Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports audit, compliance, ... + Certified Professional Coder (CPC) - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid...to have):** + Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred.… more
    Commonwealth Care Alliance (08/31/25)
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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 ... 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
    Commonwealth Care Alliance (08/26/25)
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  • Patient Account Representative - Medicare…

    Guidehouse (Lewisville, TX)
    …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 ... claims + Complete all business-related requests and correspondence from...Spending Accounts + Short-Term & Long-Term Disability + Tuition Reimbursement , Personal Development & Learning Opportunities + Skills Development… more
    Guidehouse (10/24/25)
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