- 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
- Humana (Nashville, TN)
- …on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement/ editing logic and Humana system logic **Use your skills ... closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Molina Healthcare (Sterling Heights, MI)
- …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
- UPMC (Pittsburgh, PA)
- …clinical coding edits. Your insights will help us ensure compliance with Medicare , Medicaid , and other payor requirements while identifying opportunities for ... Analyst to play a critical role in shaping how claims are processed and paid. This is your opportunity...be the go-to expert for payment accuracy and claim editing . You'll work closely with our external software vendor… 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
- City and County of San Francisco (San Francisco, CA)
- … claims processing, and/or collecting healthcare service reimbursements or medical claims from Medi-Cal ( Medicaid ), Medicare , insurance, third party ... and tracking of issues; + Performs revenue analysis related to charge errors, claims submission volume, denials and trends based on claim type and/or payer,… more
- Humana (Charleston, WV)
- …Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The ... Demonstrate ability to problem-solve complex coding issues + Experience with Medicare and Medicaid coding guidelines + Strong data entry and attention to detail… more
- Stanford Health Care (Palo Alto, CA)
- …after a detailed review of medical records. Ensure compliance with Medicare , Medicaid , third-party guidelines, Local Coverage Determinations (LCD), National ... while identifying instances of overpayments and underpayments. Proficiency in healthcare claims analysis, including the ability to review, interpret, and evaluate … more