- 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 ... claims + Complete all business-related requests and correspondence from...Spending Accounts + Short-Term & Long-Term Disability + Tuition Reimbursement , Personal Development & Learning Opportunities + Skills Development… 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
- Prime Healthcare (Inglewood, CA)
- …new members to join our corporate team! #LI-JV1 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
- Humana (Annapolis, MD)
- …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 Developing… more
- Highmark Health (Buffalo, NY)
- …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 (ID)
- …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
- 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
- Accura Healthcare (Omaha, NE)
- …laws and regulations pertaining to the position. QUALIFICATIONS: + Knowledge of Medicaid , Medicare , and insurance reimbursement systems, including billing ... designated locations in order to meet and maintain goals. + >Monitors Medicaid billing and claims are accurately and timely filed on behalf of their designated… more
- Banner Health (AZ)
- …medical insurance AR and physician fee-for-service billing is ideal and knowledge of Medicare , Medicare Advantage, Medicaid , and Commercial insurance is ... work and receive care. **The PFS Insurance Follow-Up Representative (Ambulatory Denials, Medicare team)** is responsible for following up with assigned payer for… 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
- Centene Corporation (Jefferson City, MO)
- …knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred. **For Claims ... 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
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Claims Recovery Manager is responsible for leading the recovery operations within the MSO Claims department. This role ... or GED + Minimum 5 years of progressive experience in healthcare claims recovery, payment integrity, or post-payment audit functions, preferably within a multi-plan… 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
- Abbott (Austin, TX)
- …and appeal processes and other related matters requiring a specialized knowledge of Medicare , Medicaid and Private Payer reimbursement procedures and ... ** is responsible for implementing and managing clinical trial reimbursement processes to secure Medicare and private...On** + Review clinical investigative plan and payer policies ( Medicare , Medicare Advantage, Medicaid and… more
- New York State Civil Service (Albany, NY)
- …May serve as subject matter expert (SME) for the following subject/program areas: Medicaid , SSI, Social Security, Medicare , Food Stamps, Outside Hospital Care ... NY HELP Yes Agency Mental Health, Office of Title Resources & Reimbursement Agent 1/Trainee 1&2 (NYS HELPS), Central Office; Occupational Category Financial,… more
- Fairview Health Services (Minneapolis, MN)
- …Medical Billing + 3 years Three+ years medical billing or collection experience, Medicare , Medicaid , Third Party experience + Pharmacy Technician MN Certified ... Ensure accurate and timely billing, collections, appeal of home infusion claims . Perform collection tasks to obtain payments. Analyze accounts for documentation,… 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
- J&J Family of Companies (Cincinnati, OH)
- …approval processes and business acumen. + Understanding of Medicare , Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and ... + Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of… more