- Athens Health and Rehabilitation LLC (Huntsville, AL)
- …the Director of Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested. During facility visits, ... well as Company policy and procedure Directs the MDS assessment and Medicare related activities of the assigned facilities, ensuring accurate and timely assessments… more
- Morningstar Living (Nazareth, PA)
- …it pertains to Medicare , HMO reimbursement issues. Responsible for the managed Medicare products, appeals and submission of weekly documentation. What do I ... need in the role of RN Resident Assessment Coordinator (RNAC)? Must maintain current RN licensure by the Pennsylvania State Board of Nurse Examiners. Two (2) years of RNAC or related experience preferred. RAC-CT certification required. Strong knowledge of MDS… more
- Macpower Digital Assets Edge (Los Angeles, CA)
- Job Summary: The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the ... may be considered. minimum of 3-5 years of Managed Care, Medicaid, Medicare experience required. minimum of 3-5 experience in design and delivery (facilitating… more
- Texas Health Resources (Arlington, TX)
- …including but not limited to the review and preparation on of Medicare /Medicaid cost reports, regulation appeals , Disproportionate Share Hospital (DSH), and ... and other programs. Oversees or supports departments and entities with various Medicare and Medicaid Supplemental Payment and incentive programs including but not… more
- Molina Healthcare (Long Beach, CA)
- …Provides coordination and processing of pharmacy prior authorization requests and/or appeals . Explains Point of Sale claims adjudication, state, NCQA, and CMS ... and providers with initiating oral and written coverage determinations and appeals . Records calls accurately in call tracking system. Maintains specific quality… more
- Novir (Milwaukee, WI)
- …have some experience in medical billing, with a particular focus on insurance appeals and vaccination reimbursement. This role will support our billing department by ... vaccinations. Assist in resolving denied or rejected claims through effective insurance appeals . Follow up with insurance carriers on outstanding claims and provide… more
- Molina Healthcare (Long Beach, CA)
- …for medical necessity. Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of ... the medical director, and quality improvement staff. Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. Reviews quality referred… more
- Savista (Camden, NJ)
- …programs. Facilitate the application process for programs such as Medicaid, Medicare , Disability, hospital charity care or unique requirements for non-traditional ... including setting up medical appointments, completing disability applications, submitting appeals , and following through on resolution of applications. Manage… more
- CenCal Health (Santa Barbara, CA)
- …functions; assists subordinate managers in resolving medical claims review, grievances, appeals , and other medical management issues Works closely with the CMO ... concurrent (hospital/ skilled nursing facility) and retro authorizations, and appeals ; approves/denies or offers medical alternatives according to CenCal Health… more
- Quipt Home Medical Corp (Mesa, AZ)
- …Researches payer denials and billing which resulted in denial and payment delay Submits appeals to payers based on review of medical records and in accordance with ... payer requirements Performs resubmissions. Submits retro-authorizations and appeals . Identifies denial patterns and assists management with root cause analysis,… more
- CentraState Healthcare System (Freehold, NJ)
- …other regulatory agency rules and regulations including The Joint Commission, CMS, Medicare , including but not limited to, knowledge of CMS rules regarding ... Observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures. Maintains knowledge of continuum of cares resources and provides education and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. Provides guidance and interpretation on issues of medical ... status based on length of stay, level of care requirements and Medicare regulations, and Major Complications or Comorbidities (MCC) / Complications or Comorbidities… more
- Vensure Employer Services (Huntington Beach, CA)
- …claims for Skilled Nursing Facility services Manage billing for Cal Optima, Medi-Cal, Medicare , and HMO plans Follow up on claims to ensure timely reimbursement ... Knowledge, Skills, and Abilities Proficiency in billing Cal Optima, Medi-Cal, Medicare , and HMOs Strong knowledge of SNF-specific billing codes and reimbursement… more
- Wealthy Group of Companies LLC (Overland Park, KS)
- …secure funding through grants orcommercial insurance reimbursements (no Medicare /Medicaid), ensurecompliance with federal and state regulations including ... insurance-drivencare models, while overseeing denial trends, analyzing patterns, andsupporting appeals when appropriate to maximize reimbursement andclient retention in… more
- MetroPlusHealth (New York, NY)
- …including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, ... and marketing activities. Support Coverage for Retrospective Reviews and BH UM Appeals as needed #LI-Remote Minimum Qualifications Master's Degree required Minimum 3… more
- UHS (Riverside, CA)
- …to ensure compliance with Federal and State laws and regulations (Centers for Medicare and Medicaid Services, Department of Managed Health Care, Department of Health ... preferred. Minimum 3 years' experience in Medical Management (Utilization Management, Appeals and Grievances, and/or Concurrent Review). Over 2 years of experience… more
- Rochester Regional Health (Newark, NY)
- …the medical management department in the tracking, trending and reporting of appeals and charge recovery information. Conducts reviews of cost outliers and ... tools highly desired. May need previously experience in CMS, Medicaid/ Medicare billing, and other regulatory processes. EDUCATION: LICENSES / CERTIFICATIONS:… more
- Molina Healthcare (Omaha, NE)
- …8am-5pm PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and ... subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and...with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for … more
- Elevance Health (Tampa, FL)
- **Nurse Appeals - Medicare ** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law. The **Nurse Appeals - Medicare ** is responsible for investigating and processing and medical necessity … more
- Molina Healthcare (St. Petersburg, FL)
- **Job Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for ... direct oversight, monitoring and training of provider disputes and appeals to ensure adherence with Medicare standards...disputes and appeals to ensure adherence with Medicare standards and requirements related to member and provider… more
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