- 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 ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
- Zelis (Plano, TX)
- …good understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing , contracting, preferred-provider ... personal interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer… more
- Central Maine Medical Center (Lewiston, ME)
- …and medical terminology * Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid . What It's Like Working At CMH: We are ... Wellness Program + Essential Duties: Review claims using electronic claims software -compliance products, editing and transmitting. 2. Completes processing… more
- Centene Corporation (Phoenix, AZ)
- …in Nursing and 4 - 6 years of related experience. Expert of Medicare and Medicaid regulations preferred. Expert of utilization management processes preferred. ... + Performs clinical review of outcomes including creating and editing denial letters with the correspondence team based on...coding issues and provides supplemental information to resolve denial claims + Acts as a point of contact for… more
- Centene Corporation (Little Rock, AR)
- …in Nursing and 2 - 4 years of related experience. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes ... for improvement. + Performs clinical review of outcomes including creating and editing denial letters with the correspondence team based on denial determinations in… more