- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA-Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more
- Molina Healthcare (Oshkosh, WI)
- **JOB DESCRIPTION** Candidate must reside in Wisconsin. Remote with field travel required in assigned territory. **Job Summary** Responsible for increasing ... membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare -Medicaid recipients within approved market areas to achieve… more
- University of Southern California (Alhambra, CA)
- As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various ... the standard policy for maintaining the CDM. The RI Specialist is responsible for the timely and accurate synchronization...provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date.… more
- Providence (MT)
- …the PSJH System Revenue Integrity Chargemaster (RICDM) Dept. team, the Senior CDM Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding ... and billing regulations and accurately represents services provided. The Senior CDM Specialist acts as the liaison between the Hospital ministry and the PSJH System… more
- Guidehouse (Minneapolis, MN)
- …**Travel Required** **:** None **Clearance Required** **:** None This position is fully remote **What You Will Do** **:** + Under the direction of the Director ... services through efficient review and timely resolution of assigned Medicare and third party payer accounts that are subject...hold edits, and claim denials. **This position is 100% remote ** .Daily duties for this position include: + Responsible… more
- Stanford Health Care (Palo Alto, CA)
- …Health Care job.** **A Brief Overview** The Single Path Coding (SPC) Specialist -Level 2 is an advanced coder position responsible for reviewing clinical ... HCPCS and the American Medical Association (AMA) CPT Assistant. The SPC Coding Specialist II serves as a subject matter expert in hospital and professional coding,… more
- Marshfield Clinic (Marshfield, WI)
- …exciting missions in the world!** **Job Title:** SHP Pharmacy Benefits Specialist ( Remote ) **Cost Center:** 682891381 SHP-Pharmacy **Scheduled Weekly Hours:** ... **Job Description:** **JOB SUMMARY** The Security Health Plan (SHP) Pharmacy Benefit Specialist is responsible for the daily administration of the SHP pharmacy… more
- Molina Healthcare (Omaha, NE)
- **Job Description** **Job Summary** The Sr Specialist , Member & Community Interventions oversees and implements new and existing clinical quality member intervention ... initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality focused interventions and programs… more
- BrightSpring Health Services (Englewood, CO)
- …Inc. is a leading provider in home Infusion therapy. We are looking for a Billing Specialist to join our Revenue Cycle Management team as we grow to be one of the ... top home infusion providers in the country. The Billing Specialist will report to the Billing Manager and work...discussions. Schedule: 40 hours per week - Hybrid or Remote We Offer: * Medical, Dental & Vision Benefits… more
- Huron Consulting Group (Chicago, IL)
- …member of Huron's Research Office Team. As a Clinical Research Administrative Specialist II, you'll assist Huron's Research Office team in developing coverage ... You will also assist in review and feedback for Clinical Research Administrative Specialist I projects and will begin to support client contacts for client specific… more
- National Health Transport (Miami, FL)
- Summary: Ambulance Medical Billing Specialist is responsible for billing and collection processes for National Health Transport's ambulance trips. Ambulance Medical ... Billing Specialist answers inquiries from insurance companies, patients, and processes...+ Medical coding training and experience + Familiar with Medicare /Medicaid laws and billing + Certified Ambulance Coder helpful… more
- CVS Health (Springfield, IL)
- …member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly ... or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. + **Community Resources:** Familiarity with community… more
- Trinity Health (Columbus, OH)
- …and up to date CPC certification preferred + Completes and submits Medicare Patient Assessment Forms and maintains accurate database of submission and payment. ... + Certified Risk Adjustment Coder certification within one year of hire required. + Minimum of two years of experience in medical coding and billing required. + Understanding of various medical claims formats. + Working knowledge in medical terminology, CPT… more
- CareFirst (Baltimore, MD)
- …Administration + Knowledge of healthcare or health insurance payor industry ( Medicare , Medicaid, Commercial, DSNP and other payor programs), including legal and ... regulatory requirements. + Solid understanding of CPT-4, HCPCS, revenue and ICD coding, medical terminology, claims payment, contract negotiations and problem resolution. **Knowledge, Skills and Abilities (KSAs)** + Understanding of multiple reimbursement… more
- Molina Healthcare (Cedar Rapids, IA)
- …tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources ... to validate overpayments made to providers. * Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. * Enters and updates recovery applications and… more
- MetroLink (Los Angeles, CA)
- Social Media Specialist Print (https://www.governmentjobs.com/careers/scrra/jobs/newprint/5183448) Apply Social Media Specialist Salary $63,277.00 - $98,080.00 ... Annually Location California 90017, CA Job Type At Will Full Time Remote Employment Flexible/Hybrid Job Number 23-2400206 Department Marketing & Partnerships Opening… more
- Home Care Providers of Texas (Springfield, MO)
- Job Title: Enterprise Authorization Specialist Department: Revenue Cycle Reports To: Authorization Supervisor Employment Type: [Full-Time / Part-Time / Remote / ... Onsite] Position Summary The Home Health Authorization Specialist is responsible solely for obtaining, managing, and maintaining prior authorizations for home health… more
- MD Anderson Cancer Center (TX)
- …of the PBS Billing Specialist position is to bill and follow-up on Medicare claims within regulatory guidelines. The PBS Billing Specialist must ensure that ... and employees throughout the revenue cycle. *SUMMARY* The PBS Billing Specialist provides professional expertise in daily governmental billing and follow-up… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Provides expertise to ... field. + 5 years of experience as a Sourcing Specialist or equivalent experience. **Professional Certification(s)** + Certified Purchasing...keyboard, mouse and headset. + Whether you are working remote or in the office, employees have access to… more
- Elara Caring (Grand Rapids, MI)
- …at the Right Time, in the Right Place. **Job Description:** **Engage Clinical Care Specialist ** The Engage Clinical Care Specialist is part of the ElaraConnect ... programs that aims to improve patient outcomes on-service. The Engage Clinical Care Specialist supports the PCS Engage and PCS Branches, acting as a liaison for… more