- Humana (Raleigh, NC)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Humana (Raleigh, NC)
- …part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible… more
- Guidehouse (Raleigh, NC)
- …and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. **This position is 100% ... for charge reconciliation audits + Escalate departments noncompliant with policy and provide action plan when needed + Responsible for the daily resolution of… more
- UNC Health Care (Morrisville, NC)
- …Medicare Advantage and Managed Medicaid policies that could potentially affect reimbursement across UNC Health, whether Hospital based billing or Physician ... Assists with being a resource, answering questions and providing information about Reimbursement Policies that currently, or will in the future, affect UNC Health.… more
- Centene Corporation (Raleigh, NC)
- …enrollment and billing. + Support development and promote adoption of sustainable, THW-specific Medicaid reimbursement processes for THWs that can be used across ... procedure to ensure health plan staff are able to facilitate enrollee and provider needs through entire case management cycle + Communicate, identify, resolve, and… more
- TEKsystems (Raleigh, NC)
- …therapy. Our expertise spans HUB services, patient assistance programs, field reimbursement , nursing, and non-commercial pharmacy - each designed to remove barriers ... outbound calls that keep patients on therapy, ensure timely medication delivery, and provide the support that makes a real difference in people's lives. This fully… more
- Humana (Raleigh, NC)
- …coding auditor to review inpatient hospital claims for proper reimbursement , handle provider disputes in a result-oriented and metrics-driven environment. ... Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims… more
- UNC Health Care (Chapel Hill, NC)
- …Responsible for performing a variety of complex duties in support of reimbursement from patient and insurance carriers throughout the revenue cycle from pre-service ... staff with training or techniques to increase production and quality as well as provide support for the team members that may be absent or backlogged. Perform all… more
- Gentiva (Lillington, NC)
- …hospice agency promptly if unable to complete F2F visits as scheduled. + May provide F2F coverage for multiple provider numbers with approval. **About You** ... physicians, interdisciplinary group (IDG) members, patients, caregivers, and families. + Provide clinical recommendations to the IDG based on F2F assessment… more
- PruittHealth (Raleigh, NC)
- …levels of care. 2. Must be knowledgeable of private insurance, Medicare and Medicaid coverage criteria, rules and regulations and reimbursement methodologies. 3. ... continuum and facilitating admissions into the Pruitt Health network. 5. Must provide excellent customer service to all referral sources and network of providers.… more
- Humana (Raleigh, NC)
- …for services rendered is complete, compliant and accurate to support optimal reimbursement . The Nurse Auditor 2 work assignments are varied and frequently require ... in the state they reside. + Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not… more