- HCA Healthcare (Hendersonville, 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 ... need to succeed in our organization. We are looking for an enthusiastic Medicare Specialist to help us reach our goals. Unlock your potential! **Job Summary and… more
- Prime Therapeutics (Nashville, TN)
- …every decision we make. **Job Posting Title** Medication Therapy Management Specialist **Job Description** The Medication Therapy Management (MTM) Service ... Specialist is responsible for receiving inbound and making outbound...meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid… more
- Gentiva (Nashville, TN)
- …ensures compassionate care reaches every patient, every day. As an Executive Director Specialist - RN, you'll serve as the operational and clinical leader in our ... all federal, state, and organizational standards. **What You'll Do as Executive Director Specialist - RN:** + Serve as the Administrator on record at assigned… more
- HCA Healthcare (Nashville, TN)
- …over 156,000 hours volunteering in our communities. As a Provider Enrollment Credentialing Specialist with Parallon you can be a part of an organization that is ... in our organization. We are looking for an enthusiastic Provider Enrollment Credentialing Specialist to help us reach our goals. Unlock your potential! **Job Summary… more
- HCA Healthcare (Brentwood, TN)
- …over 156,000 hours volunteering in our communities. As a Clinical Denials Coding Review Specialist with Parallon you can be a part of an organization that is devoted ... our organization. We are looking for an enthusiastic Clinical Denials Coding Review Specialist to help us reach our goals. Unlock your potential! **Job Summary and… more
- Sedgwick (Nashville, TN)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Specialist , General Liability (Property) **PRIMARY PURPOSE** : To analyze complex or ... limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests… more
- Cognizant (Nashville, TN)
- …based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/appeals ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- Cardinal Health (Nashville, TN)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of Medical, Supplemental, and pharmacy… more
- Highmark Health (Nashville, TN)
- …share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing ... interpretation, and outcomes strategic plan development. + 1 year experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Cardinal Health (Nashville, TN)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… more
- Humana (Nashville, TN)
- …the team as a Senior Product Manager working anywhere in the US. As a Specialist in NBA Execution, you'll play a hands-on role in translating strategy into real-time ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Highmark Health (Nashville, TN)
- …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) + AAPC Credentials (Outpatient): Certified Professional Coder… more
- Cardinal Health (Nashville, TN)
- …office, to verify patient specific benefits. The Benefits Verification Specialist will ask appropriate questions regarding patient's benefits and complete ... benefits a plus. + Fundamental understanding of key payers including Medicaid, Medicare and private payers + Strong customer service experience **Anticipated hourly… more
- HCA Healthcare (Nashville, TN)
- …leadership + Works with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Communicates coding revisions to the ... Reasons + As needed, may periodically be asked to perform Coding Integrity Specialist II (CIS-II) duties + Periodically works with their Manager to review individual… more