- Humana (Albany, NY)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- OhioHealth (Columbus, OH)
- …This position will be responsible for ensuring the appropriate governmental (Medicare and Medicaid ) reimbursement is received for OhioHealth. * This position is ... projects as assigned. * Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement and remaining...Hospice. Projects as assigned by Director of Revenue and Reimbursement and Manager of Reimbursement . Provide… more
- Humana (Boise, ID)
- …part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible… more
- CVS Health (Lansing, MI)
- …networks to meet accessibility, quality, financial goals and cost initiatives for our Medicaid products. + Negotiate and execute provider contracts, conduct high ... cost arrangements within defined groups. + Collaborates cross-functionally to manage Hospital , Ancillary and provider compensation and pricing development… more
- University of Rochester (Pittsford, NY)
- …and addressing consequential barriers to securing public benefits which may impact hospital reimbursement and timely discharge. + Possesses a nuanced ... Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500169 Medicaid Enrollment Work Shift: UR - Day (United States of America) Range: UR… more
- University of Rochester (Rochester, NY)
- …+ _Problem Resolution:_ Identifies barriers to securing public benefits which may impact hospital reimbursement and timely discharge. Consults with MEOS II, MEOS ... Type: Full time Scheduled Weekly Hours: 40 Department: 500169 Medicaid Enrollment Work Shift: UR - Day (United States...State of Health Certified Application Counselor (preferred) + Must provide and maintain a valid NYS Class 5 driver's… more
- Guidehouse (El Segundo, CA)
- …None **What You Will Do** **:** The **Insurance Patient Account Representative** **( Hospital Claims)** is an extension of a client's business office staff. ... from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare/ Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & CMS… more
- Geisinger (Danville, PA)
- …have a strong understanding of Medicare settlement processes, compliance requirements, and hospital reimbursement regulations. This role requires the ability to ... Summary We are seeking a detail-oriented professional with expertise in Medicare and Pennsylvania Medicaid cost reporting to join our team. The ideal candidate will… more
- Omaha Children's Hospital (Omaha, NE)
- …including knowledge of CPT, HCPCS and revenue codes and their effect on hospital reimbursement . Knowledge of the current healthcare climate, including managed ... and education. As the state's only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families-from primary and… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …records and compile documents for case presentations; + May supervise and participate in hospital Medicare and Medicaid reimbursement programs; + May testify ... high volume, we are unable to confirm receipt or provide status updates directly. For recruitment updates, please check...of care providers; + May supervise and participate in hospital Medicare and Medicaid reimbursement … more
- Omaha Children's Hospital (Omaha, NE)
- …methodologies + Conducts research on Federal and State regulations/laws + Coordinates regulatory reimbursement audits of the hospital and represents the System * ... and education. As the state's only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families-from primary and… more
- AmeriHealth Caritas (Washington, DC)
- …dual eligibility health insurance, ACA Exchange Business & DSNPs. + 5 years provider contracting/ reimbursement experience in healthcare setting. + 3 years of ... Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible… more
- Humana (Springfield, IL)
- …of our caring community and help us put health first** The Director, Provider Contracting initiates, negotiates, and executes physician, hospital , and/or other ... organization capabilities interrelate across the function or segment. The Director, Provider Contracting initiates, negotiates, and executes physician, hospital ,… more
- AmeriHealth Caritas (Southfield, MI)
- …partnership with & incentives for providers. + Ensure strategic alignment with state Medicaid agenda and compliance with provider related aspects of state ... preferred. + 10 or more years of experience years of managed care provider contracting and reimbursement experience, including in-depth knowledge of … more
- WellSense (MA)
- …Responsible for managing the assigned territory of professional, institutional and ancillary provider types in order to enhance these relationships so that Well ... Serves as the primary liaison between WellSense Health Plan ("Plan") and key provider organizations, taking the lead and promoting collaboration within Plan, as it… more
- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. * Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Humana (Sacramento, CA)
- …Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements for an ... organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex issues where the analysis of… more
- WellSense (NH)
- …environment is preferred + Experience with Medicare and Medicaid Reimbursement Methodologies + Understanding of provider coding and billing practices ... insurance that works for our members, no matter their circumstances. **Job Summary:** The Provider Relations Consultant - NH will act as the primary liaison between … more
- Molina Healthcare (West Valley City, UT)
- …* Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. * ... contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ie physician, group and hospital contracting,… more
- Commonwealth Care Alliance (Boston, MA)
- …and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital , behavioral health, ... Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience… more