- Genmab (Berkeley Heights, NJ)
- …verifications, research of prior authorizations and support through the appeals processEvaluate and refer patients to appropriate financial assistance ... and oral) product reimbursement, including but not limited to Medicare , Medicaid and commercial insurance carriers, Prior Authorization submissions/appealsUnderstanding… more
- Bryan Health (Lincoln, NE)
- …screening, insurance verification for benefits, medical necessity reviews, denial and appeals and coordinates admissions with admitting physicians and staff. Serves ... as an internal and external resource regarding Medicare /Medicaid rules, regulations and policies; 3 rd party and managed care contracts, and authorization for… more
- PharmaCord (Jeffersonville, IN)
- …for coverage and provide education support for the office to submit pre-determinations, appeals and/or peer to peer reviews with payors, as applicable Assist offices ... directly within physician practices or outpatient clinics billing commercial insurances, Medicare , and Medicaid preferred Bi-lingual in English and Spanish or… more
- Molina Healthcare (Tampa, FL)
- Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist. This position is remote and will be working Pacific Standard hours. Highly Qualified ... Will Have The Following Experience: + Strong understanding of UM, Appeals , and Medicare knowledge + Strong understanding of CMS regulations, Medicare … more
- CVS Health (Hartford, CT)
- …based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff *… more
- Molina Healthcare (Augusta, GA)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to ... internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine Medicare ...claims appeals using support systems to determine Medicare appeal and claim outcomes. + Requests and reviews… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
- Elevance Health (Las Vegas, NV)
- …Prepare and perform supervisory review of cost report reopenings. + Manage caseload of Medicare cost report Appeals + Position papers + Jurisdictional Reviews + ... **Audit & Reimbursement Senior- Appeals ** **_Location:_** _This role enables associates to work...Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare… more
- CVS Health (Harrisburg, PA)
- …on behalf of members or providers as assigned. **Required Qualifications** + 1-2 years Medicare part C Appeals experience. + Experience in reading or researching ... issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from… more
- Molina Healthcare (IA)
- …benefits (COB), subrogation and eligibility criteria. + Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... Molina Healthcare is hiring for an Appeals & Grievance Specialist. This role is 100%...the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Highly Qualified Applicants Will… more
- Molina Healthcare (Orem, UT)
- …of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- NTT DATA North America (Plano, TX)
- …Senior Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end ... delivery of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end… more
- Guidehouse (Lewisville, TX)
- …office and three days 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 patients and insurance companies. + Responsible for working on 40-60 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients in… more
- US Tech Solutions (RI)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- US Tech Solutions (May, OK)
- …authorizations. **Responsibilities:** + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal notes or fax requests ... for clinical information to decision cases + Utilize work instructions and Medicare guidelines for accurate case processing. + Comply with CMS mandated timelines… more
- Mohawk Valley Health System (Utica, NY)
- …clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. ... prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals .… more
- Centene Corporation (Little Rock, AR)
- …Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare ), Disenrollments, Appeals , and Grievances. + Collaborates with Provider ... enhances and maintains provider relationship across all product lines ( Medicare , Medicaid, Ambetter). Supports the development and implementation of quality… more
- University of Michigan (Ann Arbor, MI)
- Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and ... knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain compliance… more
- Elevance Health (Norfolk, VA)
- …Vendors (Vision, Dental, Transportation) strongly preferred + Experience with Medicaid and Medicare grievances and appeals processes + Experience with network ... issue management for multiple states and for Medicaid and Medicare lines of business. **How You Will Make an...development within Medicaid and Medicare space preferred + Data analysis experience strongly preferred… more
