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Health care industry and Medicare Part D rules and regulations, Medicaid services, claims adjudication process, CMS guidance, and the life cycle of PDE data. Proven understanding of the health care industry and or BCBSMN area s of Medicare Part D rules and regulations, Medicaid services, claims adjudication process, CMS guidance, and the life cycle of PDE data.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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5+ years of experience in Medicaid billing, reimbursement, claim payment or cost reporting. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
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This individual will manage/lead a team of 10-20 associates arbitrating respective payor and provider reimbursement offers under the Center of Medicare and Medicaid Services (CMS) No Surprises Act (NSA.
$120,500 - $180,700 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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The Sr Medicaid Reimbursement Regulatory Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including institutional, as well as professional payment systems.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe.
$33,280 - $47,271 a yearFull-timeExpandApply NowActive JobUpdated 20 days ago - UpvoteDownvoteShare Job
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Position has primary responsibility for claims adjudication, claims payment and check processing for all healthcare claims and for assisting providers in troubleshooting claims issues. Maintains HIPAA compliance and identifies potential issues surrounding fraud, waste or abuse of Medicaid funds are appropriately reported to Compliance department.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Knowledge of Medicare and Medicaid billing & payment and coverage guidelines. Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Area’s of Medicare Part D rules and regulations, Medicaid services, claims adjudication process, CMS guidance, and the life cycle of PDE data. Serves as a conduit between customers, vendors, and the IT Solutions development team from medium to large sized projects encompassing Medicare Part D and Medicaid.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Develop knowledge and understanding in pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs) and Third-Party Insurances) Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues as needed.
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Process Medicare, Medicaid, Hospice and Insurance claims for payment. Assist with DME claims adjudication. Knowledge of Medicare, Medicaid, coding and insurance processing a plus but will train.
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Ensure Model N system integrity for all Medicaid calculations and formulas used in proper adjudication. The Associate Director, Medicaid Rebates Operations will lead the Medicaid team to ensure compliance with the Medicaid Drug Rebate Program, handling all Medicaid obligations for Novartis and its affiliates.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Knowledge of UB04 / CMS1500 claims, ICD-10 / Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission, Medicare and Medicaid reimbursement methodologies including APR DRG / Exempt Units / APG / RBRVS / APC.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Follows-up and corresponds with responsible parties in accordance to Center of Medicare & Medicaid Services (CMS) and commercial payer guidelines and requirements. Examines accounts for accuracy and provides adequate documentation to payers within compliance of regulations for justification of all services rendered for medical treatment to process claims for adjudication or reimbursement.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Working knowledge of CPT codes, UB04 and 1500 claims processing, Texas Medicaid requirements, state and federal poverty guidelines, and state/county indigent program provisions and limitations.
Full-timeExpandApply NowActive JobUpdated 4 days ago
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