- HCA Healthcare (Bowling Green, KY)
- …**Introduction** Do you want to join an organization that invests in you as a Medicare Specialist ? At Parallon, you come first. HCA Healthcare has committed up ... have the opportunity to make a difference. We are looking for a dedicated Medicare Specialist like you to be a part of our team. **Job Summary and… more
- Vanderbilt University Medical Center (Nashville, TN)
- …Payor/Provider Enrollment **Job Summary:** JOB SUMMARY A payor enrollment specialist is responsible for tracking the process of enrolling healthcare ... providers with insurance payors or health plans. This typically involves completing and submitting applications, verifying credentials, ensuring compliance with payor requirements, and maintaining accurate records. They may also handle provider updates,… more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as an Impatient Coding Denial Specialist ? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... We are looking for a dedicated Impatient Coding Denial Specialist like you to be a part of our...CMS/AHCA policies and regulations + Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and… more
- Prime Therapeutics (Nashville, TN)
- …our passion and drives every decision we make. **Job Posting Title** MTM Specialist Sr **Job Description** The Senior Medication Therapy Management (MTM) Service ... Specialist will act as a Subject Matter Expert for...meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid… more
- HCA Healthcare (Nashville, TN)
- …for benefits may vary by location._** We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide all patients with ... apply! **Job Summary and Qualifications** Seeking a Clinical Denials Coding Review Specialist , who is responsible for applying correct coding guidelines and payor… more
- Elevance Health (Nashville, TN)
- …our infusion centers, and the home setting._ **Senior Credit & Collections Specialist - Paragon Healthcare** **Locations:** + TX-PLANO, 3033 W PRESIDENT GEORGE BUSH ... Alternate locations may be considered. The **Senior Credit & Collections Specialist - Paragon Healthcare** is responsible for complex collection activities related… more
- Elevance Health (Nashville, TN)
- …of life through home-care and community based services. Clinical Support Specialist **Location:** This role enables associates to work virtually full-time, with ... ensures essential face-to-face onboarding and skill development. The **Clinical Support Specialist ** is responsible for providing day-to-day support to care team… more
- Molina Healthcare (Bowling Green, KY)
- …accordance with the standards and requirements established by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as team lead for a small ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Molina Healthcare (Bowling Green, KY)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- Humana (Nashville, TN)
- …+ Facilitating cross-functional teams in various departments in Medicaid and/or Medicare + Strong influencing and process implementation skills. + Ability to ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Elevance Health (Nashville, TN)
- …prior authorization requests from physicians offices and ensures compliance with Medicare and Medicaid requirements; informs relevant parties of all prior ... + Experience working with electronic health records preferred. + Basic knowledge of Medicare and Medicaid preferred. + Experience talking with members on the phone… more
- Intermountain Health (Nashville, TN)
- …Billing + Documentations + Communication + Customer Follow-Ups + Time Management + Medicare Billing + Medical Billing + Microsoft Office + Computer Literacy + HIPAA ... Billing, Follow-Up, Call-Center, or Collections) + Knowledge of Medicaid and Medicare billing regulations Preferred Qualifications: + Knowledge of Revenue and ICD… more
- Cardinal Health (Nashville, TN)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of Medical, Supplemental, and pharmacy… more
- CenterWell (Nashville, TN)
- …advanced practice professionals, Pharm D, Care Coach Nurse, MA, Behavioral health specialist , Quality based Coder, Referral Coordinator and more. Our approach allows ... for TB. Preferred Qualifications: + Active and unrestricted DEA license + Medicare Provider Number/ Medicaid Provider Number + Experience managing Medicare … more
- CenterWell (Nashville, TN)
- …has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary ... Identify and act on opportunities to better manage & coordinate with high-quality specialist , hospital, and community partners to serve patient needs and deepen our… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Molina Healthcare (Bowling Green, KY)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management +… more
- Molina Healthcare (Bowling Green, KY)
- …and/or regulatory requirements. * Monitors and reports network adequacy for Medicare and Medicaid services. * Develops strategies to improve EDI/MASS rates. ... Provides training and guidance as needed to the Contract Managers and Contract Specialist (s). * Helps develop and utilize standardized contract templates and Pay for… more
- HCA Healthcare (Nashville, TN)
- …Description + Works with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Communicates coding revisions to the ... Reasons + As needed, may periodically be asked to perform Coding Integrity Specialist II (CIS-II) duties + Periodically works with their Manager to review individual… more
- CenterWell (Nashville, TN)
- …assignments. The Clinical Programs Pharmacy Technician Representative 2 Community Resource Specialist works within the Maximize Your Benefits department to assist ... government sponsored support such as Low Income Subsidy (LIS) and the Medicare Savings Program (MSP) for medication assistance. Works within defined parameters to… more