- 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
- Humana (Hartford, CT)
- …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 +… more
- Zelis (Plano, TX)
- …business administration, or a related field + Five+ years of experience in Medicaid billing, reimbursement , claim payment or cost reporting. + Experience with ... that shape who you are. Position Overview The Sr. Medicaid Regulatory Pricer Analyst will collaborate with the Zelis... Medicare / Medicare Advantage or commercial billing and reimbursement … 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
- Molina Healthcare (Milwaukee, WI)
- …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
- 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:Coder Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services… more
- TEKsystems (Baltimore, MD)
- …highly preferred but not needed! Description Will be mainly focused on their Medicare billing (80-100 claims /month) and will be working other commercial payers ... TekSystems is currently hiring for a Medicaid Medical Biller in the Baltimore area! MUST...when caught up on medicare Timely resolution and collection of assigned account balances… more
- Humana (Lansing, MI)
- … Research and Resolution Lead and is responsible for tracking and trending Michigan Medicaid claims data and completing root cause analyses of claims ... to execute effectively on assigned work. **Position Responsiilities** + Routinely track provider claims data for providers in the Michigan Medicaid network to… more
- Humana (Lansing, MI)
- … Research and Resolution Lead and is responsible for tracking and trending Michigan Medicaid claims data and completing root cause analyses of claims ... to execute effectively on assigned work. **Position Responsibilities** + Routinely track provider claims data for providers in the Michigan Medicaid network to… more
- Humana (Springfield, IL)
- …hospitals, nursing facilities, and/or HCBS and LTSS providers) + Experience working with Medicaid Long Term Support Services, (LTSS), waiver claims + Partners ... provides solutions, and coordinates with business teams to resolve claims issues + Knowledge of current Medicaid ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… 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
- AssistRx (Louisville, KY)
- …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
- 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