- 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
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the...Research and analyze impacts of various State and Federal Medicare and Medicaid policies, regulations, legislation and other proposals,… more
- Point32Health (MA)
- …. **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and Grievances using ... and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the ...Committee for Quality Assurance / NCQA and Centers for Medicare & Medicaid Services / CMS), providers, high profile… 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
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** **Position Summary:** The Senior Reimbursement Analyst is responsible for providing cost report preparation cost report appeals audit ... services of Dignity Health. The position maintains current knowledge of Medicare Medicaid and other State and Federal regulations. The Sr. Reimbursement… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** The **Senior Reimbursement Analyst i** s responsible for providing cost report preparation, cost report appeals , audit preparation and other ... services of Dignity Health. The position maintains current knowledge of Medicare , Medicaid and other State and Federal regulations. The Sr. Reimbursement… more
- State of Colorado (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), (Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4889241) Apply Board Certified Behavior Analyst (BCBA), (Clinical Behavioral Specialist II) - Grand Junction… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Senior (Sr.) Accountng and Reporting Analyst position is responsible for identifying and compiling information to effectively report costs ... reimbursement from various government programs. The Sr. Accounting and Reporting Analyst utilizes strong data analytic skills to identify issues and researches… more
- Corewell Health (Grand Rapids, MI)
- …steps of the member appeal and fair hearing processes for all non- Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- Avera (Sioux Falls, SD)
- …4,000 nationwide to achieve a double 5-star rating from the Centers for Medicare and Medicaid (CMS). Be apart of something great! **Position Highlights** **Position ... Summary** The Denial Prevention Analyst coordinates facility wide denial and denial prevention information for Avera Heart Hospital and North Central Heart. This… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Reimbursement Analyst - SeniorDepartment: Reimbursement Specialist - Finance Location: Riedman Campus SUMMARY: Provide and maintain Hospital reimbursement ... expertise as it relates to Medicare , Blue Cross and Medicaid. Prepare annual institutional cost...able items which could enhance reimbursement. Prepares and submits appeals . + Accurately prepares and submits on a timely… 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
- Lompoc Valley Medical Center (Lompoc, CA)
- …Activities + Professional Development Position Duties/Responsibility: + Knowledge of the appeals and denials processes for Medicare , Medi-Cal, and other ... equivalent. + Experience: Prefer 2+ years of experience working with commercial, Medicare , Medi-Cal and HMO insurance procedures. Working knowledge of full cycle… 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)
- …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
- State of Colorado (Denver, CO)
- …with APS requirements regarding CAPS use in coordination with the APS data analyst and APS policy unit; interprets Adult Protective Services policy for county staff ... (non-direct contact): CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks, Professional License verification (licensure… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager, Nursing positions are required to ... enforcement actions for the Division, including processing license revocations, Medicare and Medi-Cal de-certifications, and criminal complaints; and provides… more
- City and County of San Francisco (San Francisco, CA)
- …issued by a national certifying body or organization recognized by Medicare . + Specific specialties may have additional requirements. Applicants must meet ... may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department...regarding this recruitment or application process, please contact the analyst , Stephen Lee at ###@sfdph.org or ###. We may… more
