- Lyric (Newtown Square, PA)
- …understanding of US health insurance payers including Commercial, Medicare , Medicaid (FFS and MCOs), third-party claims processing (including paper & ... subject matter expert on CPT, HCPCS, ICD10CM coding and claims edit logic (including NCCI, LCDs, State Medicaid...of experience in a health insurance payer or automated claims editing solution, as a payment, reimbursement … more
- Stony Brook University (East Setauket, NY)
- …+ Experience with Inpatient and Outpatient billing requirements (UB-04/837i) and/or CMS Medicare and New York Medicaid reimbursement methodologies. + ... support day-to-day business functions including but not limited to: billing, claims analysis appeals, follow-up, financial assistance and customer service. **Duties… more
- Commonwealth Care Alliance (Boston, MA)
- …initiatives to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid - Medicare Plan withhold measures, quality ... CAHPS, HOS) and value-based contract performance metrics + Experience with Medicare Advantage, Medicaid ; and dually eligible populations **Desired Experience**… more
- Commonwealth Care Alliance (Boston, MA)
- …Required Knowledge, Skills & Abilities (must have): - Strong understanding of claims processing, reimbursement methodologies, and payment policies, with the ... their impact on provider operations and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance… more
- Commonwealth Care Alliance (Boston, MA)
- …experience + Experience in health plan provider relations. **Experience (Desired)** + Medicare / Medicaid experience preferred. + Experience with CPT coding and ... with key providers; orient providers on CCA's policies related to: Claims and service recovery; Program benefits; Clinical initiatives; Referral and authorization;… more
- Commonwealth Care Alliance (Boston, MA)
- …Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare / Medicaid ) + Experience in health plan provider relations + Experience ... + **Operational Excellence:** + Collaborate with cross-functional teams (eg, Claims , Credentialing, Clinical Care Management, Member Services, Provider Services,… more
- 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 (Little Rock, AR)
- …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
- Humana (Nashville, TN)
- …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… 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
- 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
- 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
- Baylor Scott & White Health (Austin, TX)
- …paced environment independently and with cross functional groups.Knowledge of ACA, Medicare , Medicaid , MCO, TPA business requirements preferred.Experience with ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… 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
- 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
- AssistRx (Dallas, TX)
- …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
