- Stanford Health Care (Palo Alto, CA)
- …the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong ... analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding professionals, and… more
- Stanford Health Care (Palo Alto, CA)
- …and regulatory reports to government agencies, including but not limited to: - Medicare and Medi-Cal cost reports -Financial disclosures to the Department of Health ... timely and accurate filing of annual government cost reports, including Medicare , Medi-Cal, and HCAI submissions. + Maintain comprehensive knowledge of federal… more
- Stony Brook University (East Setauket, NY)
- …business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue ... on rejected or denied claims, improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection agencies. + Identify issues… more
- PharmaCord (Lexington, KY)
- …includes completing benefit investigations, tracking prior authorizations / denial appeals , and assisting patients or other callers/stakeholders through resolution ... detailed records of reimbursement activities, including claims status, payments, and appeals . Generate reports and analysis as needed to identify trends and… more
- 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
- Sun Pharmaceuticals, Inc (Syracuse, NY)
- …expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals , exceptions, denials, coding and payer payment guidelines , payer ... care to support patient options. + Possess expertise in Medicare policies and the variations within all parts of... policies and the variations within all parts of Medicare + Ensure processes are in place to drive… more
- Stanford Health Care (Palo Alto, CA)
- …- Payer clerical and technical denial review and request processing including basic appeals - Payment posting and batch reconciliation - Credit balance review and ... to payers + Reviewing and resolving payer rejections, denials, and performing appeals as necessary + Electronic or hardcopy claims editing and submission to… more
- University Health (San Antonio, TX)
- …preferred. Knowledge of payor guidelines and contracts is required. Experience in appeals with third-party payors, resulting in reimbursement, is a plus. Must have ... working knowledge of computers, calculators and general office equipment. 10-key experience. Online Medicare /Medicaid and Commercial verification is preferred.… 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
- Sprenger Wellspring Silver Maple (Lorain, OH)
- …experience in Insurance Billing field. Essential Job Functions: Responsible for Medicare , managed care, Mycare, and ancillary billing. Monthly review of outstanding ... balances. Responsible for appeals . Assists with insurance verifications when needed. The position offers a competitive wage based on experience, and many other… more
- Commonwealth Care Alliance (Boston, MA)
- …Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals ; Policies and procedures. + Identify opportunities for training and ... + Experience in health plan provider relations. **Experience (Desired)** + Medicare /Medicaid experience preferred. + Experience with CPT coding and authorization… more
- Mom's Meals (Ankeny, IA)
- …Resolve claim rejections timely and resolve claim denials through research, appeals , claim corrections/resubmission, and follow-up with health plans + Ensure ... compliant billing, following specific regulations of multi-state Medicaid and MCO's, Medicare Advantage, and Older Americans Act programs + Responsible for ensuring… more
- Mom's Meals (Ankeny, IA)
- …Resolve claim rejections timely and resolve claim denials through research, appeals , claim corrections/resubmission, and follow-up with health plans + Ensure ... and compliant billing, following specific regulations of multi-state Medicaid and MCO's, Medicare Advantage, and Older Americans Act programs + Responsible for… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... plan, progress notes and discharge summary related information as required by Medicare , MediCal, Title 22 and other mandated regulations according to Department… 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
- HCA Healthcare (Nashville, TN)
- …VA). Do you want to join an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? At Parallon, you come first. HCA Healthcare has ... have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Specialist Medicare RN or LPN like you to be a part of our team. **Job… 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
- Humana (Topeka, KS)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Elevance Health (Woodbridge, NJ)
- …programs, guidelines, and processes are strongly preferred. + Solid knowledge of Medicare Grievance and Appeals rules and regulations is highly preferred. ... **Manager II Grievance/ Appeals ** **- Claims Support** **Office Locations:** _The selected...regulated audits. + Oversight of the IRE portions of Medicare audits and universe production. + Serves as a… 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
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