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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers compensation claims.
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About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
$260,000 - $287,000 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Under the supervision of the Revenue Cycle Manager, this position is responsible for the timely and accurate billing of commercial/group insurance/Medicare/Medi-Cal/managed care and self-pay home health/hospice accounts, posting of payments/remittance advices, review of unpaid claims/patient accounts and use procedural guidelines to reduce the outstanding dollars on accounts receivable.
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3+ years experience in public or private third-party reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales. Offer office education during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
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Or equivalent education/experience 5 years claims processing experience with 2 years as a Claims Manager, Or 3 years managed care experience, Or Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
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Understanding of claims processing rules, managed care benefits, and adjudication. Ensure quality processing of various types of claims (e.g., in/outpatient hospital claims, Medi-cal, Commercial, and Medi-care claims.
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We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers.
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States with low cost malpractice coverage, capped malpractice claims, low managed care, simple licensing process and affordable cost of living. Hospital, located in Fort Wayne, Indiana, has an excellent opportunity for the right BC/BE Gynecological Oncologist.
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Keep informed on issues and trends relating to Healthcare, Workers Compensation, Bill Review, Cost Containment, Managed Care, and related areas. As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services unit involving complex/large medical claims; analyzing and optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse, negotiators and related staff in an environment of continual performance improvement.
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Verifying daily Census Verify all billing and financial data for new admissions Medicare A & B Billing, Claims Corrections and Follow-up Managed Care , Claims Corrections and Follow-up Private Pay Billing and Collections.
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Integrated Healthcare Partners (IHP) is a not-for-profit organization working in partnership with the RI Executive Office of Health and Human Services as well as with local managed care organizations.
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Minimum five years of financial analysis/business, medical claims adjusting background preferably in Workers Compensation with progressive management responsibility. Prepare legal/settlement assessments, manage litigation/bill disputes, respond to defense attorney requests, and provide testimony as an expert witness as required.
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MRG Exams is a leading provider of Independent Medical Evaluations (IME) and Permanent Partial Impairment Ratings (PPIR) services for the Ohio Bureau of Workers' Compensation (BWC), third-party administrators, Managed Care Organizations (MCOs), and employers.
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MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Minimum 3 years of clinical review experience with utilization management, case management, or health care claims auditing experience preferred. Develop and maintain knowledge of CMS Managed Care and Program for All Inclusive Care of the Elderly (PACE) regulations and guidance.
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