- Novo Nordisk Inc. (Traverse City, MI)
- …level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …and communicate potential impacts of those changes.Change Management - Continuously review the financial procedures and drive new processes and/or system ... of all channels of managed care environment in the US (commercial, Medicare , Medicaid, etc.); preferredSufficient understanding of financial matters to challenge and… more
- Molina Healthcare (Long Beach, CA)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
- CenCal Health (Santa Barbara, CA)
- …departments and external partners to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements, as well ... proposing recommendations for improvement. Contribute in the new implementation and review of documented audit processes to ensure compliance against requirements… more
- Southeast Texas HR (Beaumont, TX)
- …is a full-time day position. Pay will start at $15.81+ per hour. Responsibilities Review and correct all Medicare claims daily. Verify and update information to ... ensure accurate patient billing records. Review all Medicare remittance reports for errors, denials, and incorrect payments. Review and track all aging… more
- Actalent (Fort Lauderdale, FL)
- …in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth ... patient satisfaction, safety, and appropriate length of stay. Responsibilities Review prior authorization requests for medical necessity and appropriateness using… more
- Optum (San Antonio, TX)
- …with Microsoft Office, Internet and e-mail Beginner level of knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing...to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 6+ months of experience with Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 1+ years of experience with Medicare Part D, particularly the pharmacy record review , claims, billing, and ... information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing...to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject… more
- FROEDTERT HEALTH (Milwaukee, WI)
- …Refers cases to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary team as it ... Bachelor's Degree in Nursing is preferred. SPECIAL SKILLS DESCRIPTION: Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission,… more
- Optum (San Antonio, TX)
- …6+ months of experience with knowledge of medical terminology Knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- Optum (San Antonio, TX)
- …clinic or hospital 6+ months medical terminology knowledge base Knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- Texas Health Resources (Arlington, TX)
- …programs. Manges outside consulting relationships including but not limited to the review and preparation on of Medicare /Medicaid cost reports, regulation ... and other programs. Oversees or supports departments and entities with various Medicare and Medicaid Supplemental Payment and incentive programs including but not… more
- Hackensack Meridian Health (Hackensack, NJ)
- Overview The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions of care,… more
- Molina Healthcare (Long Beach, CA)
- …the Company's assigned contact to log tickets for premium restoration such as Medicare Secondary Payer and ESRD. JOB QUALIFICATIONS Required Education HS Diploma or ... GED Required Experience 1-3 years' experience in an administrative support. Preferred Education Associate degree Preferred Experience 3+ years' experience in an administrative support role. To all current Molina employees: If you are interested in applying for… more
- MBK Senior Living (Scottsdale, AZ)
- …(serving from the left, clearing used dishes between courses, etc.) 100% - Review residents dietary needs, as outlined by Supervisor 5% - Track resident attendance ... provide care and services in a facility that receives Medicare or Medicaid funding. If employed at one of...at one of our senior living communities that receives Medicare or Medicaid funding, team members must not be… more
- The Christ Hospital (Cincinnati, OH)
- …to maximize reimbursement. Maintain knowledge of current HMO/PPO/Medicaid/ Medicare /commercial insurance regulations and requirements. Requires working knowledge ... Necessity guidelines have been met. Prepares and completes documentation that establishes Medicare Compliance such as Medicare Secondary Payor Questionnaire and… more
- CentraState Healthcare System (Freehold, NJ)
- …are not limited to: Level of Care Determination: Completes initial medical necessity review on all ED patients with potential for admission, works with providers to ... other regulatory agency rules and regulations including The Joint Commission, CMS, Medicare , including but not limited to, knowledge of CMS rules regarding… more
- The Villages Health (The Villages, FL)
- …of Clinicians for the Villages Health, LLC. This process includes review of credentialing packet upon receipt by Clinician, preparation/maintenance of provider ... detailed instructions on payor-specific application requirements for participation with Medicare , Medicaid, and commercial health plans. Continuously analyzes the… more
- Stony Brook Medicine (Stony Brook, NY)
- …Department may include the following but are not limited to: Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the ... Follows cases for authorization for in patient stay. Staff review short stay, long stay and complex cases to...days. Documents over utilization of resources and services. All Medicare cases are reviewed for level of care on… more
