- HCA Healthcare (Nashville, TN)
- …**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
- Molina Healthcare (Bowling Green, KY)
- **Job Description** **Job Summary** The Sr. Specialist Member Engagement representative is responsible for monitoring and evaluating member interactions to ensure ... members, and manager. + Basic understanding of managed healthcare systems and Medicare . **PREFERRED EDUCATION:** Associate or bachelor's degree in social work, Human… 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)
- …We care like family! Jump-start your career as an Inpatient Coding Specialist today with Parallon. **Benefits** Parallon, offers a total rewards package that ... Come join our team as an Inpatient Coding Resolution Specialist . We care for our community! Just last year,...with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assigns interim… more
- J&J Family of Companies (Nashville, TN)
- …**Job Description:** We are searching for the best talent for Area Business Specialist to be in Nashville TN. **About Immunology** Our expertise in Innovative ... of the way. Learn more at https://www.jnj.com/innovative-medicine As the Area Business Specialist (ABS), you will: + Ensure appropriate identified new and existing… 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
- Molina Healthcare (Bowling Green, KY)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Bowling Green, KY)
- …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation. + Develops and maintains documentation and guidelines for all… 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
- 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
- TEKsystems (Smyrna, TN)
- Description The Billing Support Specialist will be responsible for ensuring orders are tasked appropriately between different systems. A Billing Support ... Specialist determines where orders must be tasked to ensure...documentation (chartnotes, prescription request, medical records, etc) to bill Medicare . -Ensuring orders are tasked appropriately between different systems… more
- Cardinal Health (Nashville, TN)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… 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
- Highmark Health (Nashville, TN)
- …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) + AAPC Credentials (Outpatient): Certified Professional Coder… more
- HCA Healthcare (Nashville, TN)
- …leadership + Work with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Communicate 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
- Signature Healthcare (Glasgow, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... to make a Difference + Degree and certification as a therapeutic recreation specialist ; or + Certified Activity Director by the National Certification Council for… 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