- Commonwealth Care Alliance (Boston, MA)
- … Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports audit, compliance, ... 011250 CCA- Claims **Position Summary:** Reporting to the Director, ...and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director… more
- 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 ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement ...new CPT and HCPCS codes for coding logic, related Medicare / Medicaid policies to make recommend reimbursement… more
- Guidehouse (San Antonio, TX)
- …TX office._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... Flexible Spending Accounts + Short-Term & Long-Term Disability + Tuition Reimbursement , Personal Development & Learning Opportunities + Skills Development &… more
- Prime Healthcare (Redding, CA)
- …Responsibilities The Senior Medicare - Medicaid Biller/Collector ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Senior Medicare - Medicaid Biller/Collector ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- Humana (Denver, CO)
- …The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, ... Business Intelligence Engineer will be responsible for: + Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities +… more
- Zelis (Plano, TX)
- …the personal interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory ... a related field + Five+ years of experience in Medicaid billing, reimbursement , claim payment or cost...or cost reporting. + Experience with Medicare / Medicare Advantage or commercial billing and reimbursement … more
- TEKsystems (San Antonio, TX)
- …collections accounts receivable, Emr, Epic, claims follow up, claims denials, claims appeals, medicare , medicaid , EOB, rebill claims Top Skills ... * Stay current on communication relating to healthcare reimbursement and regulatory changes * Develop and maintain positive...collect on outstanding claims . - highly prefer medicare or medicaid collections experience * High… more
- TEKsystems (Las Vegas, NV)
- …resolving unpaid or underpaid insurance claims , with a focus on Medicare and Medicaid accounts. This fast-paced, production-based role requires an analytical ... and utilize provider portals for claims resolution. + Strong preference for Medicare or Medicaid collections experience. + High school diploma or equivalent… more
- RWJBarnabas Health (Oceanport, NJ)
- …indicators associated with disease processes and pharmacology is required. + Knowledge of Medicare and Medicaid billing and coding regulations. + Must have ... Inpatient Coding Quality Officer III - ( Medicare )Req #:0000183242 Category:Coder Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services… more
- Integra Partners (Troy, MI)
- …$70,000/Annually Responsibilities and Duties + Be prepared to appeal or correct CRT claims in compliance with Medicare , Medicaid , and commercial insurance ... internal teams.. + Maintain up-to-date knowledge of payer policies, Medicare / Medicaid requirements, and regulatory changes affecting CRT reimbursement . +… more
- BlueCross BlueShield of North Carolina (NC)
- …program are administered timely, accurately and in compliance with the Centers for Medicare and Medicaid Services (CMS) requirements. Ensures that future program ... **Job Description** This role oversees the Medicare Prescription Payment Plan (M3P), working closely with...service, legal, and finance teams + Familiarity with pharmacy claims processing, benefit adjudication, and installment billing logic +… more
- Zelis (TX)
- …claims processed through our modeling systems, validating pricing accuracy across Medicare , Medicaid , and commercial reimbursement methodologies, and ... a detail-oriented and technically skilled analyst to support healthcare claims repricing and data validation efforts. In this role,...audit claim data. + Evaluate pricing scenarios based on Medicare , Medicaid , and commercial reimbursement … more
- Healthfirst (NY)
- …+ Research and identify published updates to payment methodologies, fee schedules and claims editing policies from Medicare , Medicaid , and third-party ... and ensure proper system functionality and quality outcomes including claims configuration, provider set up, reimbursement methodology...MHS and/or MACESS systems a plus. + Knowledge of Medicare and Medicaid programs and reimbursement… more
- BrightSpring Health Services (Uniondale, NY)
- …Specialist - 3rd Party: + Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate ... financial risks + Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D...D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement … more
- Central Maine Medical Center (Lewiston, ME)
- …and medical terminology * Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid . What It's Like Working At CMH: We are ... other every day. Central Maine Healthcare is seeking a Claims Processing Rep to join our Team. This is...we prioritize work/life balance, community-based wellness initiatives and tuition reimbursement or student loan repayment for ALL of our… more
- Intermountain Health (Juneau, AK)
- …in Medicare , Medicaid , and/or governmental reporting + Experience with Medicare and Medicaid reimbursement world and cost reports. + Experience ... and exception requests to appropriately maximize reimbursement . Interacts with Medicare Administrative Contractor, State Medicaid , and hospital personnel as… more
- Ultimate Care Inc (Brooklyn, NY)
- … Submission: Prepare and submit Medicare claims to the Centers for Medicare & Medicaid Services (CMS) accurately and in a timely manner. + ABNs (Advance ... Specialist will be responsible for managing the billing and collections process for Medicare / Medicaid Managed Care claims . You will work closely with… more
- Amgen (Philadelphia, PA)
- …to HCPs on how the products are covered under the benefit design (Commercial, Medicare , Medicaid ). + Serve as a payer expert for defined geography and ... **Job Title:** Tezspire Field Reimbursement Manager (FRM) **Job Summary:** The Tezspire Field...cross functional partner meetings + Experience with commercial payers, Medicare plans, and state Medicaid in a… more
- Masonicare (Wallingford, CT)
- …in geriatric nursing; Requires at least two (2) years experience with federal Medicare / Medicaid and Managed Care reimbursement systems with a thorough ... and monthly end of close meetings. + Assists with Medicare denial claims /reviews when need is identified...billing office. + Keeps abreast of changes in the Medicare , Medicaid and managed care areans and… more