- CVS Health (Fresno, CA)
- …for all products. Responsible for serving as the point of contact for the appeal if there is an inquiry from leadership, compliance and State regulators. Understand ... and adapt to departmental process and policies. Medicare knowledge is a plus. Fast Turn Around of...times, with accurate case resolution or research. Remain a part of the solution by escalating issues that may… more
- CVS Health (Hartford, CT)
- …Director role are related to Medicare Appeals.* Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part ... D appeals.* Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in the Second Look Review (SLR)… more
- Martin's Point Health Care (Portland, ME)
- … Medicare Focus Key Outcomes: + Processes, researches, investigates, and resolves Medicare Part C reconsiderations with 100% compliance. + Assists ... the Medicare Managed Care Manuals pertaining to Part C appeals + Responsible and accountable...in accordance with Tricare and NCQA guidelines. + Presents appeal cases to the Appeals Committee, records meetings, and… more
- State of Colorado (Pueblo, CO)
- …analysis and actively participates in "Reset to Evolve" (previously known as C -Stat) initiatives identified by CDHS-OCFMH, providing accurate information and data + ... duty statements Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights Minimum Qualifications: Education/Licensure/Certification/Experience: + Master's degree in… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... role is considered a production role and remains as part of the Nurse Appeal Consultant job...as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... role is considered a production role and remains as part of the Nurse Appeal Consultant job...as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team… more
- Iowa Department of Administrative Services (Woodward, IA)
- …support, and habilitation services for individuals with intellectual disabilities. As a vital part of the Iowa Department of Health and Human Services (HHS), WRC ... Auditor, Generally Accepted Accounting Practices (GAAP), Social Security, Medicaid, Medicare , and other state/federal regulations. + Quality Assurance: Review and… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This ... role is considered a production role and remains as part of the Nurse Appeal Consultant job...as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team… more
- Conduent (Los Angeles, CA)
- …or rebill claims with corrections. + Required to have an understanding and working knowledge of Medicare Part A, B, C and D, including benefits and coverage. ... insurance responsibility, and to determine correct overpayment amount. + General understanding of: + Medicare Part A, Part B and Part D + Health… more
- The Joint Commission (Oakbrook Terrace, IL)
- …direct reports. People and other resources are managed indirectly as part of cross-functional team delegation required to complete the project. **Responsibilities** ... and certification regulations and policies, and the Centers for Medicare & Medicaid Services (CMS) strategy for transition to...ensure high quality final products. Alters writing style to appeal to various audiences as needed. Willingness to seek… more
- Marshfield Clinic (Neillsville, WI)
- …This brand new state-of-the-art facility opened in May 2021, you will be part of a robust department with a welcoming environment. If desired, this opportunity ... insurance + Relocation support Marshfield Clinic Health System is a non-profit 501( c )(3) organization. This may qualify you for additional state and/or federal… more