- Neighborhood Health Plan of Rhode Island (Smithfield, RI)
- …Category Professional / Experienced Description The Policy and Claims Research Specialist is responsible for supporting the Payment Integrity initiatives and ... and operational units to ensure timely resolution of open issues. The Specialist assumes ownership and accountability for the timely and accurate identification and… more
- Clever Care Health Plan (Huntington Beach, CA)
- …the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who ... the supervision of the Vice President of Operations, the Credentialing Specialist supports all credentialing operations, including direct monitoring of the delegated… more
- Knox Community Hospital (Mount Vernon, OH)
- …pre-certifications in a timely manner. Reviews and resolves pre-authorization/pre- certification issues. Responsible for notifying appropriate hospital personnel of ... for gathering and submitting all necessary clinical documentation with pre- certification /authorization initially and as directed by insurance payer and Case… more
- PharmaCord (Cincinnati, OH)
- …and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist ), CHES ... issue resolution. Knowledge of healthcare compliance regulations, including HIPAA and Medicare /Medicaid guidelines. Bi-lingual skills are a plus. We are located in… more
- HCA Healthcare (Nashville, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Medicare Specialist with Parallon, you can be a part of an ... you need to succeed in our organization. We are looking for an enthusiastic Medicare Specialist to help us reach our goals. Unlock your potential! **Job… more
- CVS Health (FL)
- …sales talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist . The position will be a part of a ... specialized team who will focus on educating existing Medicare members on available plan offerings to help meet their specific healthcare needs. This role is ideal… more
- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance...to have the one or all of the required certification OR willing to get certified within 1 year… more
- Ochsner Health (New Orleans, LA)
- …Healthcare Research Compliance (CHRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or related certification . **Knowledge Skills and ... in applying and improving compliance policies, procedures and processes. Perform Medicare Coverage Analysis (MCA) for sponsored research projects. Configure studies… more
- Southeast Health (Dothan, AL)
- …Using internal and external computer systems and payer portals, work traditional Medicare and Medicare Advantage/Replacement inventory to full resolution. Job ... to obtain accurate reimbursement; + Understands the use of and navigation of Medicare 's DDE system and other governmental and commercial payer websites for claim… more
- SUNY Upstate Medical University (Syracuse, NY)
- …Syracuse Inc. (UUMAS) is seeking a Registered Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) ... Primary Care clinic Medical Directors and Nurse Leadership. Duties/Responsibilities: Identify Medicare patients overdue for their Medicare Annual Wellness Visit… more
- Louisiana Department of State Civil Service (LA)
- Medical Certification Specialist 1 - 2 (Field Office 3) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5060748) Apply Medical ... Certification Specialist 1 - 2 (Field Office...to determine compliance with state and federal regulations, including Medicare and Medicaid standards. + Review facility records, policies,… more
- Charter Care Health Partners (Providence, RI)
- …all authorizations and pre-certs as required by the individual insurance company. The specialist will be familiar with and understand Medicare , Medicaid, other ... government payers, Commercial and HMO/PPO Payers guidelines and principals. Education: High school graduate or GED required. Associate's level degree preferred. Experience: Prior experience working in a related role in a medical office or other health care… more
- New York State Civil Service (Buffalo, NY)
- NY HELP No Agency Mental Health, Office of Title Medical Specialist 3, Buffalo Psychiatric Center, P27054 Occupational Category Administrative or General Management ... NY Zip Code 14213 Duties Description As a Medical Specialist 3, you would serve as chief of service;...for full and unconditional participation in the Medicaid and Medicare programs.OROpen Competitive:Possession of a license to practice medicine… more
- New York State Civil Service (Thiells, NY)
- …Yes Agency People With Developmental Disabilities, Office for Title Medical Specialist 2 Occupational Category Health Care, Human/Social Services Salary Grade 38 ... Code 10984 Duties Description Primary Duties and ResponsibilitiesAs a Medical Specialist , you would actively participate in diagnosing and treating patients within… more
- Ventura County (Ventura, CA)
- Medical Billing Specialist II - Patient Financial Services Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4940099) Apply Medical Billing ... Specialist II - Patient Financial Services Salary $49,302.23 -...for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance reimbursement requirements. The ideal candidate… more
- New York State Civil Service (Corinth, NY)
- …Yes Agency People With Developmental Disabilities, Office for Title Medical Specialist 2 Occupational Category Health Care, Human/Social Services Salary Grade 38 ... State NY Zip Code 12822 Duties Description The Medical Specialist 2 provides primary medical care, working in collaboration...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- New York State Civil Service (Rochester, NY)
- …Yes Agency People With Developmental Disabilities, Office for Title Medical Specialist 1 Occupational Category Health Care, Human/Social Services Salary Grade 35 ... Code 14620 Duties Description Primary Duties and Responsibilities:As a Medical Specialist , you would actively participate in diagnosing and treating patients within… more
- New York State Civil Service (Brooklyn, NY)
- NY HELP Yes Agency Mental Health, Office of Title Medical Specialist 2 (NY HELPS), Kingsboro Psychiatric Center - Outpatient, P26760 Occupational Category Health ... is recruiting a physician to serve as a Medical Specialist 2. Candidates from outside or within State Service...to practice medicine in New York State and have certification by Member Board of the American Board of… more
- University of Colorado (Aurora, CO)
- …as Medicaid or Medicare , or other resources available to patients. + Possess certification as a Colorado Peer and Family Specialist (CPFS), or another Peer ... the training already. + The employee must obtain the Colorado Peer and Family Specialist (CPFS) certification within 6 months of hire date ( certification … more
- New York State Civil Service (Bellerose, NY)
- NY HELP No Agency Mental Health, Office of Title Medical Specialist 2 (NY HELPS), New York City Children's Center - Bronx Campus, P27060 Occupational Category Health ... is recruiting a physician to serve as a Medical Specialist 2 at its Bronx Campus. Candidates from outside...to practice medicine in New York State and have certification by Member Board of the American Board of… more
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