- 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, ... + Certified Professional Coder (CPC) - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid...to have):** + Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred.… 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 (Lewisville, TX)
- …from home._** **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 (Ontario, CA)
- …seeking new members to join our corporate team! Responsibilities The Senior Medicare - Medicaid Biller/Collector is responsible for both billing and collections, ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- Prime Healthcare (Redding, CA)
- …family. For more information, visit www.shastaregional.com . Responsibilities The Senior Medicare - Medicaid Biller/Collector is responsible for both billing and ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- Highmark Health (Charleston, WV)
- …interpret data in government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to ... of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is...is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue… more
- Molina Healthcare (Scottsdale, AZ)
- …their financial and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB ... and manage information from large data sources. + Analyze claims and other data sources to identify early signs...- 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare… more
- Staffing Solutions Organization (Albany, NY)
- …eligibility and claims systems. + Take the appropriate actions regarding Medicaid enrollment and premium reimbursement . + Demonstrate systems processes for ... may be received from a variety of sources such as Centers for Medicare and Medicaid Services (CMS), Insurance Carriers, and others. + Ability to problem solve… more
- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the ... individuals with chronic conditions or disabilities. + Strong understanding of Medicare - Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.… more
- Baylor Scott & White Health (Austin, TX)
- …paced environment independently and with cross functional groups.Knowledge of ACA, Medicare , Medicaid , MCO, TPA business requirements preferred.Experience with ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… 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 ) RemoteReq #:0000183242 Category:Healthcare Operations, Revenue Cycle, and...EHR which may affect the patient's future care, insurance claims and coverage. When accounts are not reviewed and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment,… more
- BrightSpring Health Services (Louisville, KY)
- …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
- LA Care Health Plan (Los Angeles, CA)
- …annual (DMHC) filing submissions. Serves as primary contact and liaison for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care ... years of experience performing claims audits or claims processing related to Medi-Cal, Medicare , and/or...benefits including + Paid Time Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision… more
- Centene Corporation (Jefferson City, MO)
- …of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred. Pay Range: $15.58 - ... claims . Verify and update information on the submitted claims . Review work processes to determine reimbursement ...submitted claims . Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in… more
- AssistRx (Dallas, TX)
- …program business rules. + Strong understanding of Government benefits such as Medicare , Medicaid , and Tricare. + Documenting and reporting payment information. ... DUTIES AND RESPONSIBILITIES: + Processes medical copay claims in accordance with program business rules. +...prescription plans and billing policies to ensure compliance and reimbursement . + Monitor profitability of orders, manage claim queues… more
- Waystar (Louisville, KY)
- …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... of hospital & professional coding and billing workflows and the provider reimbursement process, obtained either through direct experience in a healthcare setting or… more
- Amgen (North Miami, FL)
- …information to HCPs on how the products are covered under the benefit design (Commercial, Medicare , Medicaid ) + Serve as a payer expert for defined geography and ... the lives of patients while transforming your career. **Field Reimbursement Manager - Miami, FL** **What you will do**...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
- Ventura County (Ventura, CA)
- …for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance ... Experienced in leading and training staff on Managed Care, Medicaid , Medi-Cal, Medicare , and Commercial Insurance, they...with billing and processing claims for timely reimbursement and compliance with Medi-Cal, Medicare , and… more