- CVS Health (Fresno, CA)
- …for all products. Responsible for serving as the point of contact for the appeal if there is an inquiry from leadership, compliance and State regulators. Understand ... and adapt to departmental process and policies. Medicare knowledge is a plus. Fast Turn Around of...times, with accurate case resolution or research. Remain a part of the solution by escalating issues that may… more
- CVS Health (Hartford, CT)
- …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 (Nashville, TN)
- **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)
- … Medicare Focus Key Outcomes: + Processes, researches, investigates, and resolves Medicare Part C reconsiderations with 100% compliance. + Assists ... the Medicare Managed Care Manuals pertaining to Part C appeals + Responsible and accountable...in accordance with Tricare and NCQA guidelines. + Presents appeal cases to the Appeals Committee, records meetings, and… 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
- Iowa Department of Administrative Services (Independence, IA)
- …of the following: + Compliance with The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other applicable standards and regulations. + ... classification: 1) All of the following (a, b, and c ): a. Licensure as Registered Nurse in the State...years of education and/or full-time experience (as described in part b), where thirty semester hours of accredited college… more
- Robert Half Legal (Concord, CA)
- …will play a critical role in supporting the appeals process with Medicare 's Provider Reimbursement Review Board, ensuring an efficient and effective workflow. This ... flexible hybrid schedule. Key Responsibilities: + Draft and maintain appeal documents. + Organize and manage case files. +...and filing. + Ability to work independently and as part of a team. Robert Half is the world's… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …and is the second largest insurance program in the State of Iowa. Be part of an organization that is continually working to modernize and innovate solutions to ... with sister agencies in addition to the Centers for Medicare and Medicaid Services (CMS) regulators. Tasks involved include:...experience. 3) All of the following (a, b, and c ): a. Two years of full-time professional-level work experience… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Provides guidance on and expert interpretation of Joint Commission standards and Medicare requirements, professional standards of practice, and law and regulation to ... measures, survey outcomes, and data submitted by organizations as part of the intracycle monitoring process in order to...Accreditation Committee of the Board of Commissioners including the appeal process. 4. Works closely with OQPS to provide… more
- The Joint Commission (Oakbrook Terrace, IL)
- …direct reports. People and other resources are managed indirectly as part of cross-functional team delegation required to complete the project. **Responsibilities** ... and certification regulations and policies, and the Centers for Medicare & Medicaid Services (CMS) strategy for transition to...ensure high quality final products. Alters writing style to appeal to various audiences as needed. Willingness to seek… 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
- Robert Half Accountemps (Temple City, CA)
- …management. * Set up payment plans for accounts with collection issues. * Prepare appeal letters and act as the point of contact between the insurance and collection ... Demonstrate a strong understanding of insurance guidelines including HMO/PPO, Medicare , Medicaid, and other payer requirements and systems. *...processes. * Ability to work independently, as well as part of a team, to meet deadlines and maintain… more