- 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
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… 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
- Molina Healthcare (Bowling Green, KY)
- **Job Description** **Job Summary** The Specialist , Member & Community Interventions implements new and existing clinical quality member intervention initiatives ... including all lines of business ( Medicare , Marketplace, Medicaid) Executes health plan's member and community...or Healthcare Administration + 1 year of experience in Medicare and in Medicaid managed care + Certified Professional… more
- Molina Healthcare (Bowling Green, KY)
- Molina Healthcare is in search of an experienced Sr Digital Marketing Specialist . The Sr. Specialist , Digital Marketing will be responsible for analyzing and ... communicator, and a desire to improve processes **Preferred:** + Medicaid or Medicare Health Plan experience + Strong analytical skills **PHYSICAL DEMANDS:** Working… 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
- Molina Healthcare (Bowling Green, KY)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Bowling Green, KY)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Health Care Service Corporation (Nashville, TN)
- …* Bachelor Degree in Computer Science or Information Technology related Medicare experience preferred** * Ability to execute * Experience with Cognizant ... software platforms - Elements, Facets, QNXT \#INCR \#LI-BS1 \#LI-Hybrid **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation,… more
- Molina Healthcare (Bowling Green, KY)
- …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation. + Develops and maintains documentation and guidelines for all… more
- Signature Healthcare (Bowling Green, KY)
- …choice in the healthcare industry. Overview The ideal Clinical Reimbursement Specialist Candidate is very detailed orientated, organized, self-motivated, a love for ... Prospective Payment Systems (PPS), Quality Measures (QM's), Medicaid Casemix and Medicare /Medicaid guidelines for all SHC Stakeholders. + Assist with design and… more
- Molina Healthcare (Bowling Green, KY)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… 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