- CVS Health (Hartford, CT)
- …in the US.** Responsibilities of this Medical Director role are related to Part C Medicare Appeals . This position is primary on the non-regulated appeals ... team, however the expectation is to cross train for regulated appeals . * Provide support to Medicare appeal nurses * Provide after hours and weekend coverage on… more
- CVS Health (Salem, OR)
- … Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but ... to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in… more
- Humana (Sacramento, CA)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Topeka, KS)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Molina Healthcare (Spokane, WA)
- …direct oversight, monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and requirements ... for Medicare and Medicaid Services. * Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina… more
- Molina Healthcare (New Haven, CT)
- …of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- NTT America, Inc. (Plano, TX)
- …Senior Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end ... delivery of Medicare Appeals . Desire experience specifically for processes for clinical appeals coordinators but this role will be a leader in the end-to-end… more
- Guidehouse (San Antonio, TX)
- …of our San Antonio, TX office._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service + ... Billing + UB-04 & CMS 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients… more
- St. George Tanaq Corporation (Little Rock, AR)
- …Experience and Skills** + Must have 2-3 years of medical dispute resolution or Medicare appeals , medical review, clinical, or related experience in a healthcare ... college or university in healthcare or related discipline. Additional experience in Medicare appeals , medical review, clinical, or other related experience in… more
- US Tech Solutions (RI)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information...coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. +… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** + Utilizing multiple software systems to complete Medicare appeals case reviews + Meeting or exceeding government ... requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels… more
- St. George Tanaq Corporation (Lansing, MI)
- …Requirements **Required Experience and Skills** + One (1) year of Medicare appeals , medical review, clinical, healthcare regulatory interpretation/application, ... college or university in healthcare or related discipline Additional experience in Medicare appeals , medical review, clinical, or other related experience in… more
- Baptist Memorial (Memphis, TN)
- …Coordinator-RAC TPE Job Code: 21540 FLSA Status Job Family: FINANCE Job Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical ... of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare /Medicaid Appeals Process. Familiarity of billing regulations including federal and… more
- US Tech Solutions (May, OK)
- …authorizations. **Responsibilities:** + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal notes or fax requests ... for clinical information to decision cases + Utilize work instructions and Medicare guidelines for accurate case processing. + Comply with CMS mandated timelines… more
- Mohawk Valley Health System (Utica, NY)
- …clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. ... prevent denials or carved out days when appropriate. Provide telephonic and written appeals as requested for commercial payors. + Perform reviews and appeals .… more
- Novant Health (Winston Salem, NC)
- …maintains knowledge of processes such as petitioning for guardianship and navigating the Medicare appeals process. + Willingness to cross train between Inpatient ... and Emergency Departments to assist during periods of need. + Communicates individualized plan of care and patient's progress toward goals to all members of the care team including the patient and his/her chosen support system/legal guardian/Care Coordinator.… more
- Centene Corporation (Atlanta, GA)
- …Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare ), Disenrollments, Appeals , and Grievances. + Collaborates with Provider ... enhances and maintains provider relationship across all product lines ( Medicare , Medicaid, Ambetter). Supports the development and implementation of quality… more
- City of New York (New York, NY)
- …Conduct one-on-one counseling sessions with beneficiaries to answer questions and clarify Medicare Advantage plan specifics. Appeals and Grievances Support: - ... (HIICAP) helps older adults navigate the complexities of all components of Medicare . HIICAP conducts public outreach presentations and workshops to older adults,… more
- Skyline Nursing Center (Dallas, TX)
- …pay billing and ensures that the Centralized Statement process is followed. Manages Medicare ADRs and appeals per established procedure. Ensures that the ... office operations in Long Term Healthcare, preferred. + Knowledge of Medicare and Medicaid + Collections experience preferred Skyline Nursing Center provides… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
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