- Henry Ford Health System (Troy, MI)
- … Advantage, Medicare -Medicaid Program (MMP), and Medicaid lines of business. Analyst must identify trending issues on an ongoing basis and provide root/cause ... prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial,...analysis when required. The Analyst will work with HAP's medical directors, nurses, pharmacists,… more
- CVS Health (Phoenix, AZ)
- …do it all with heart, each and every day. **Position Summary** + Processes appeals and ensures timely and accurate completion. + Maintains a caseload and monitors ... to Medical Directors and enters all data related to appeals and case reviews into a database. + Participates...addressed. **Required Qualifications** + 1-2 years of experience in Medicare , AHCCCS, and the healthcare industry + Strong reading… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements ... within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director...- including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** **Position Summary:** The Senior Reimbursement Analyst is responsible for providing cost report preparation cost report appeals audit ... services of Dignity Health. The position maintains current knowledge of Medicare Medicaid and other State and Federal regulations. The Sr. Reimbursement… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** The **Senior Reimbursement Analyst i** s responsible for providing cost report preparation, cost report appeals , audit preparation and other ... services of Dignity Health. The position maintains current knowledge of Medicare , Medicaid and other State and Federal regulations. The Sr. Reimbursement… more
- State of Colorado (Denver, CO)
- Managed Care Rate & Reconciliation Analyst Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5054342) Apply Managed Care Rate & Reconciliation ... Analyst Salary $75,132.00 - $97,668.00 Annually Location Denver Metro,...and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules . Supplemental Information How… more
- Sanford Health (Fargo, ND)
- …little turnover except for retirements. **Job Summary** The Lead Reimbursement Analyst provides critical analytical and reimbursement related direction, guidance and ... Directs the implementation and monitoring of reimbursement functions, which includes Medicare , Medicaid or other third party cost reports, related audits, … more
- Alight (Salt Lake City, UT)
- **Amazing Opportunity and Great Place to Work!** **Are you an experienced Benefit Analyst looking to join a new team?** Our Story At Alight, we believe a company's ... client's office located in Salt Lake City, Utah. The Senior Health Benefits Analyst will work directly with and assist client employees, retirees, and dependents.… more
- WellSpan Health (York, PA)
- …payer denials and institutes appropriate courses of action. + Prepares detailed appeals and attends Medicare Administrative Law Judge (ALJ) hearings as ... denials management. Conducts reviews of claim denials and submits appeals . Performs a variety of functions including, but not...necessary for Medicare + Interacts with providers, managers, and staff in… more
- Centene Corporation (Jefferson City, MO)
- …outcomes, growth initiatives, and other business objectives. + Includes projects related to Medicare pre-service turnaround time and appeals as well as ensuring ... but is not limited to Claims, Product, Operations, and markets (implementation), and Medicare Planning for upcoming year. + Assists with logistics (and serves on)… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full ... documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is… more
- City and County of San Francisco (San Francisco, CA)
- …meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider ... + Possess a valid third-party billable provider certification (such as Medicare , Medi-Cal, and/or private insurance) OR have submitted a completed billable… more
- The County of Los Angeles (Los Angeles, CA)
- …quality assessment and assurance monitoring processes; and handle informal complainant appeals . Health Facilities Program Manager, Nursing positions are required to ... enforcement actions for the Division, including processing license revocations, Medicare and Medi-Cal de-certifications, and criminal complaints; and provides… more
- City and County of San Francisco (San Francisco, CA)
- …issued by a national certifying body or organization recognized by Medicare . + Specific specialties may have additional requirements. Applicants must meet ... may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department...regarding this recruitment or application process, please contact the analyst , Stephen Lee at ###@sfdph.org or ###. We may… more