- Medical Mutual of Ohio (OH)
- …operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical drug) benefit programs. Configures, implements, maintains, ... Medicare Part D (pharmacy) and Medicare Part C (medical drug)...levels of appeal , re-openings (case re-decision) and Part C organization determination, and prescriptions with… more
- CVS Health (Lansing, MI)
- …Director role are related to Medicare Appeals. * Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part D ... appeals. * Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in the Second Look Review (SLR)… more
- The Cigna Group (Bloomfield, CT)
- **Cigna Medicare Part C Appeals...Supervisor/Manager of Appeals and will coordinate and perform all appeal related duties in a Medicare Advantage ... and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and Medicaid regulations;...Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability… more
- Martin's Point Health Care (Portland, ME)
- …+ For Medicare Focused Specialist: + Researches, processes and resolves Part C reconsiderations with 100% compliance + Prepares for, and participates ... a "Great Place to Work" since 2015. Position Summary Medicare and US Family Health Plan (USFHP) Appeal...audits + Serves as the subject matter expert for Part C appeals Medicare Managed… more
- State of Colorado (Grand Junction, CO)
- …and specialized therapies Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights Experience: + None OR Education and Experience: + None ... name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
- Stanford Health Care (Palo Alto, CA)
- If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting ... supportive UM team. You can put your knowledge about Medicare , Medi-Cal, Medicaid, and bedside RN experience to great...is a plus! Our UM team is a great part of SHC's efforts in providing and directing the… more
- New York State Civil Service (Schenectady, NY)
- …must be reachable on the appropriate Civil Service eligible list.ORThis title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY ... permanently in a NY HELPS title, employees may take part in any promotion examination for which they are...Bar and 24 months of subsequent satisfactory legal experience.55 B/ C QUALIFICATIONS:Individuals certified eligible for the 55b/ c … more
- Robert Half Accountemps (Chattanooga, TN)
- …tasks related to medical collections and insurance follow-up, with a focus on Medicare and Medicaid. You will also be involved in customer communications, primarily ... email, and messaging * Process customer applications related to Medicare and Medicaid * Maintain accurate records of customer...to hospital and physician billing * Participate in the appeal process, if necessary, to ensure the benefit functions… more
- Marshfield Clinic (Neillsville, WI)
- …This brand new state-of-the-art facility opened in May 2021, you will be part of a robust department with a welcoming environment. If desired, this opportunity ... insurance + Relocation support Marshfield Clinic Health System is a non-profit 501( c )(3) organization. This may qualify you for additional state and/or federal… more