- Stanford Health Care (Palo Alto, CA)
- …as well as excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, ... **This is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in the Revenue Cycle… more
- Motion Recruitment Partners (Birmingham, AL)
- Appeals and Grievance Analyst Birmingham, Alabama **Onsite** Contract $18/hr - $28/hr Are you detail-oriented, highly organized, and passionate about making a ... difference in healthcare? We are seeking several Appeals and Grievances Consultants s for an onsite contract...ability to manage multiple priorities effectively. Prior experience with Medicare Advantage is a plus; healthcare experience in any… more
- Beth Israel Lahey Health (Charlestown, MA)
- …in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level ... gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in order to prove...large workloads. * A thorough understanding and knowledge of Medicare rules and regulations is required. * Experience with… 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
- Commonwealth Care Alliance (Boston, MA)
- …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director...- including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid… more
- Immigration and Customs Enforcement (Washington, DC)
- Summary The Claims Management Program Analyst supports the Health Plan Management Unit by managing claims, provider recruitment, and compliance with healthcare ... AND RESPONSIBILITIES: Serves in the capacity as a Claims Management Program Analyst ; handles and assists program activities and policies related to claims… more
- HCA Healthcare (Nashville, TN)
- …integrity. We care like family! Jump-start your career as a Benefits Operations Analyst today with HCA Healthcare. **Benefits** HCA Healthcare offers a total rewards ... location._** Come join our team as a Benefits Operations Analyst . We care for our community! Just last year,...place comply with all regulations (Summary of Material Modification, Medicare Part D notices, privacy notices, etc.) + Manage… more
- Trinity Health (Clive, IA)
- …functions related to home office third party cost reports, third party appeals , third party payer contract negotiations, analysis of financial impact of changes ... potential financial impact on the member organizations of major changes in Medicare and Medicaid policies. Assists in related advocacy efforts regarding such… more
- Insight Global (Mayfield Heights, OH)
- …is responsible to write epics and features to be passed off to a systems analyst who will write the user stories for the developers to code from. -The company ... all its pieces and parts. Other Responsibilities include: * The Business Analyst III is responsible for understanding the stakeholder's business rules, culture and… more
- Dignity Health (Bakersfield, CA)
- …knowledge of DHPR and CMS rules for Claim. Submission, Claim Payment, Eligibility, Appeals for Commercial, MediCare and MediCal lines of business. + Bachelor's ... **Job Summary and Responsibilities** The Provider Data Analyst is responsible for the maintenance of the...teams as needed when questions arise. The Provider Data Analyst partners with Configuration Claims and Enrollment to ensure… more
- Alight (Salt Lake City, UT)
- **Amazing Opportunity and Great Place to Work!** **Are you an experienced Benefit Analyst looking to join a new team?** Our Story At Alight, we believe a company's ... client's office located in Salt Lake City, Utah. The Senior Health Benefits Analyst will work directly with and assist client employees, retirees, and dependents.… more
- State of Colorado (CO)
- …Background check: + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide ... of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job… more
- City and County of San Francisco (San Francisco, CA)
- …but not limited to ICD-10-CM, PCS, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines, and other classification systems, as well as compliance with state ... to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or...regarding this recruitment or application process, please contact the analyst Jerome Anabu at ###@sfdph.org or ###. We may… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full ... documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is… more
- City and County of San Francisco (San Francisco, CA)
- …healthcare service reimbursements or medical claims from Medi-Cal (Medicaid), Medicare , insurance, third-party payors, and individual payors in a hospital, ... to billing for reimbursement; knowledge of priority of billing Medicare and Medi-Cal based on the patient's types of...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- State of Colorado (Jefferson County, CO)
- …Pharmacy Formulary, Behavior Plans, Infection Control Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State Personnel Procedure ... name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
- State of Colorado (Rio Grande County, CO)
- …cash, and donation accounts + Overseeing/completing regular billings for Medicare , Medicaid, Hospice, the Department of Veterans Affairs, Managed Care/Insurance ... name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
- CaroMont Health (Gastonia, NC)
- …medical record for clinical denials. Composes a detailed summary of care and sends appeals to MCO, Medicare , or RAC for reversal of original determination. May ... results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist...be cross trained to work for the Commercial Resource Analyst when the need arises. Act as liaison to… more
- State of Colorado (Pueblo, CO)
- …on Hospital Accreditation Standards, Environment of Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State Personnel Procedure ... security personnel.) + CBI & FBI fingerprint check, Colorado Court Database check, Medicare Fraud Database, TRAILS Database check. + This position will also provide… more
- City and County of San Francisco (San Francisco, CA)
- …meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider ... + Possess a valid third-party billable provider certification (such as Medicare , Medi-Cal, and/or private insurance) OR have submitted a completed billable… more
