- Southeast Texas HR (Beaumont, TX)
- …is a full-time day position. Pay will start at $15.81+ per hour. Responsibilities Review and correct all Medicare claims daily. Verify and update information to ... ensure accurate patient billing records. Review all Medicare remittance reports for errors, denials, and incorrect payments. Review and track all aging… more
- Novo Nordisk Inc. (Traverse City, MI)
- …level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …and communicate potential impacts of those changes.Change Management - Continuously review the financial procedures and drive new processes and/or system ... of all channels of managed care environment in the US (commercial, Medicare , Medicaid, etc.); preferredSufficient understanding of financial matters to challenge and… more
- Apple Rehab (Mystic, CT)
- …to billing and potential payor changes, which may include morning report, Medicare /Utilization Review , PPS, etc Communicate all information related to payor ... in long-term care billing and collections; working knowledge of State Medicaid and Medicare law and third party insurance. Patience, tact and a positive attitude… more
- WMC Health (Valhalla, NY)
- …party billing companies, Medicare and Medicaid, as well as insurance denial review as appropriate. Ability to multi-task in a fast and high pressure environment. ... Facility Billing, Insurance Verifications, Third Party Insurance coverage, Medicaid and Medicare eligibility, Insurance denial review and overturn procedures.… more
- Molina Healthcare (Long Beach, CA)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
- DHR Health (Edinburg, TX)
- …and review processes highly desirable. Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review ... to issue Hospital Issued Notice of Non-coverage and Hospital Requested Review for Medicare patients according to policy. Refers cases not meeting criteria… more
- CenCal Health (Santa Barbara, CA)
- …departments and external partners to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements, as well ... proposing recommendations for improvement. Contribute in the new implementation and review of documented audit processes to ensure compliance against requirements… more
- Windsor Health & Rehabilitation Center LLC (Windsor, CT)
- …Inovalon, sending claims to payers in a timely manner, resolving denied claims, review Medicare and Medicaid rules and claims, calling patients to discuss ... experience with Medical billing and coding training, including knowledge of Medicaid, Medicare , Insurance, and private collection in a long term setting Ability to… more
- Actalent (Fort Lauderdale, FL)
- …in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth ... patient satisfaction, safety, and appropriate length of stay. Responsibilities Review prior authorization requests for medical necessity and appropriateness using… more
- National Recruiters (Morgantown, WV)
- …physicians included What you'll do: Complete comprehensive in-home HRAs for Medicare Advantage patients Review each patient's medical history, current ... in a flexible PRN role conducting in-home Health Risk Assessments (HRAs) for Medicare Advantage members. This is a great way to supplement your income, work… more
- Optum (San Antonio, TX)
- …with Microsoft Office, Internet and e-mail Beginner level of knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing...to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 6+ months of experience with Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- InterDent (Vancouver, WA)
- …state or region to increase patient referrals, market share and/or reimbursements. Review opportunities in Medicare Advantage plans, state Medicaid programs ... terms and conditions; recommend continuation, renegotiation, or termination. Continually review existing payor agreements to ensure compliance, minimize provider… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 1+ years of experience with Medicare Part D, particularly the pharmacy record review , claims, billing, and ... information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing...to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject… more
- FROEDTERT HEALTH (Milwaukee, WI)
- …Refers cases to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary team as it ... Bachelor's Degree in Nursing is preferred. SPECIAL SKILLS DESCRIPTION: Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission,… more
- Optum (San Antonio, TX)
- …6+ months of experience with knowledge of medical terminology Knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- Optum (San Antonio, TX)
- …clinic or hospital 6+ months medical terminology knowledge base Knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- Texas Health Resources (Arlington, TX)
- …programs. Manges outside consulting relationships including but not limited to the review and preparation on of Medicare /Medicaid cost reports, regulation ... and other programs. Oversees or supports departments and entities with various Medicare and Medicaid Supplemental Payment and incentive programs including but not… more
- Hackensack Meridian Health (Hackensack, NJ)
- Overview The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions of care,… more
