- NYC Health Hospitals (New York, NY)
- …comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, ... a comprehensive claim accuracy program. The incumbent will optimize pre/post claim editing , auditing, and claim recovery programs that will drive incremental value… more
- Duke University (Durham, NC)
- …care delivery and payment reform at the state and national level, through health care claims and other Medicare and Medicaid data. The individual in this ... databases using SAS, SQL, or other language), and the editing , validation, and management of data files to support...Health Resource File, Census Data, and a variety of claims and other public use data. Constructing complex variables… more
- Commonwealth Care Alliance (Boston, MA)
- …and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims ' processing policies, coding principals and ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Zelis (Plano, TX)
- …good understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing , contracting, preferred-provider ... personal interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer… more
- Central Maine Medical Center (Lewiston, ME)
- …and medical terminology * Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid . What It's Like Working At CMH: We are ... Wellness Program + Essential Duties: Review claims using electronic claims software -compliance products, editing and transmitting. 2. Completes processing… more
- McLaren Health Care (Flint, MI)
- …system configuration and maintenance. + Two (2) years' experience in payment integrity, claims editing and recovery operations. + Affiliation with a Professional ... working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you...all operational areas including, but not limited to, membership, claims processing and plan benefits management. Assists where necessary… more
- Humana (Montgomery, AL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more
- Centene Corporation (Phoenix, AZ)
- …in Nursing and 4 - 6 years of related experience. Expert of Medicare and Medicaid regulations preferred. Expert of utilization management processes preferred. ... + Performs clinical review of outcomes including creating and editing denial letters with the correspondence team based on...coding issues and provides supplemental information to resolve denial claims + Acts as a point of contact for… more
