- Commonwealth Care Alliance (Boston, MA)
- …and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims ' processing policies, coding principals and ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Molina Healthcare (Dayton, OH)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met ... a Managed Care Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and… more
- Centene Corporation (Jefferson City, MO)
- …and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services. + Ensures Payment Integrity DRG Review ... with coding practices through a comprehensive review and analysis of medical claims , medical records, claims history, state regulations, contractual obligations,… more
- Stanford Health Care (Palo Alto, CA)
- …payer rejections, denials, and performing appeals as necessary + Electronic or hardcopy claims editing and submission to payers + Recognizing potential trends ... and procedures and medical terminology + Knowledge of payer landscape, including Medicare , Medicaid , Workers' Compensation, Managed Care, or other Commercial… more