- Motion Recruitment Partners (Durham, NC)
- Appeals Analyst Durham, North Carolina **100% Remote** Contract $20/hr - $25/hr Our client, a nationally recognized and award-winning company in the health ... insurance vertical, has a contract opening for a Appeals Analyst . They have over 4 million...with applicable mandated State (NCDOI) and/or Federal (Centers for Medicare & Medicaid Services (CMS), ERISA, etc.) accreditation agency… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the...Research and analyze impacts of various State and Federal Medicare and Medicaid policies, regulations, legislation and other proposals,… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is… 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 (Grand Junction, CO)
- Board Certified Behavior Analyst (BCBA), (Clinical Behavioral Specialist II) - Grand Junction Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4889241) Apply Board Certified Behavior Analyst (BCBA), (Clinical Behavioral Specialist II) - Grand Junction… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Accounting and Reporting Analyst position is responsible for identifying and compiling information for various governmental reports, ... including Medicare & Medicaid Cost Reports, Annual Tax Returns, Federal...(HM) hospital and assists in cost report amendments, audit, appeals and reopening process. + Independently prepares federal and… more
- Trinity Health (Livonia, MI)
- …functions related to home office third party cost reports, third party appeals , third party payer contract negotiations, analysis of financial impact of changes ... potential financial impact on the member organizations of major changes in Medicare and Medicaid policies. Assists in related advocacy efforts regarding such… more
- Avera (Sioux Falls, SD)
- …4,000 nationwide to achieve a double 5-star rating from the Centers for Medicare and Medicaid (CMS). Be apart of something great! **Position Highlights** **Position ... Summary** The Denial Prevention Analyst coordinates facility wide denial and denial prevention information for Avera Heart Hospital and North Central Heart. This… more
- CenterLight Health System (NY)
- JOB PURPOSE: The Claim Analyst will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining processes, ... outcomes and operational efficiency. + Support stakeholders in claims appeals : review and track claims appeals and...PPS is strongly preferred. + Knowledge of Medicaid and Medicare benefits, enrollment and billing, and provider contracting is… more
- University of Michigan (Ann Arbor, MI)
- Health Information Analyst II - Compliance & Auditing Apply Now **Job Summary** Use the EPIC EHR Release Module within specified timeframes to find, review, and ... Prepare medical records for on-site audits by agencies like CMS (Centers for Medicare & Medicaid Services), OIG (Office of Inspector General), The Joint Commission,… more
- Dignity Health (Bakersfield, CA)
- …knowledge of DHPR and CMS rules for Claim. Submission, Claim Payment, Eligibility, Appeals for Commercial, MediCare and MediCal lines of business. + Bachelor's ... **Responsibilities** The Provider Data Analyst is responsible for the maintenance of the...teams as needed when questions arise. The Provider Data Analyst partners with Configuration Claims and Enrollment to ensure… more
- McLaren Health Care (Bay City, MI)
- …7. Assists in educating ICM team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and methodologies. 8. ... billing processes, applicable CMS rules and billing regulations related to Medicare , Medicaid, and commercial insurance. Participates in the resolution of… more
- City and County of San Francisco (San Francisco, CA)
- …Federal laws governing reimbursement changes interprets relevant Medi-Cal and Medicare regulations; enforces existing business office procedures for claims ... collecting healthcare service reimbursements or medical claims from Medi-Cal (Medicaid), Medicare , insurance, third party payors, and individual payors in a… more
- City and County of San Francisco (San Francisco, CA)
- …related to: credentialing, verification and provider enrollment processes for Medicaid, Medicare and other federal insurance programs The 2106 Medical Staff Services ... recruitment therefore, it is their responsibility to contact the Analyst if they update their email address. Applicants will...Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis'… 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
- State of Colorado (Denver, CO)
- …improve client and staff safety, data is reported to the MHTL Homes Data Analyst . In the beginning stages of any investigation of incidents determines which events ... name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
- City and County of San Francisco (San Francisco, CA)
- …private health care and financial assistance programs including Medi-Cal and Medicare to maximize hospital reimbursement and facilitate patient care; and performs ... and private medical and financial assistance programs including Medi-Cal, Medicare , and other third-party payers. + Participates in the...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… 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