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Experience advising on statutes, regulations, and guidance documents applicable to market access activities, including Medicaid, 340B program, Veterans Administration, federal and state anti-kickback statutes, state drug pricing transparency laws, OIG guidance documents and advisory opinions, the False Claims Act, and the PhRMA Code.
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Manage a broad range of regulatory and compliance matters, including issues related to the Anti-Kickback Statute, Stark Law and/or False Claims Act, Medicare and Medicaid reimbursement, data privacy, drug diversion, licensing, research compliance, telehealth, and general compliance and risk management.
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Assist with filing warranty claims. Attend trainings to become Trane/American Standard Field Service Representative (FSR) Experience with Trane/American Standard and Mitsubishi residential HVAC products, strongly preferred.
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REQUIRED WORK EXPERIENCE: At least four years of full-time, or equivalent part-time, professional experience in social work or social casework, claims adjudication, job placement, recruitment, employment counseling, vocational or rehabilitation counseling, credit investigation, educational counseling, legal advocacy, or legal counseling.
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The Medical Billing Specialist performs a variety of functions including but not limited to navigating billing software, accurate follow up of claims, communicating with insurance carriers, requesting retro authorizations, submitting timely appeals, reading EOB’s, performing individual benefit investigations, communicating insurance plan behaviors on claim processing to management, and other related functions.
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In this position as a Coding & Clinical Auditor / DRG Specialist RN, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims.
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You'll facilitate student-led discourse, teaching students to use evidence to make sophisticated claims, and to synthesize and evaluate arguments and rhetoric. We achieve this by offering strong academic, co-curricular, and social-emotional learning that prepares students for success in college and beyond.
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Advise management of any claims that escalate, involve complaints or that need approval from outside carrier or TMHCC corporate office. Learn how to read an insurance policy, confirm coverage, gather needed data as well as learn to set up claims, enter claim payments, etc.
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3-10 + years of experience with casualty claims and assumed reinsurance claims. Investigate, evaluate, and dispose of moderately complex insurance and/or reinsurance claims in keeping with sound claim practices and company procedures.
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Process patient referrals, pre-authorization requests, and insurance claims (as applicable). Process patient referrals, pre-authorization requests, and insurance claims (as applicable). Experience with electronic health records (EHR) systems (a plus.
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The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs.
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LogixHealth was founded in the 1990s by physicians to service their own practices and has grown to become the nation’s leading provider of unsurpassed software-enabled revenue cycle management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting dashboards for clients in 40 states.
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You will formulate the upstream strategy (Portfolio, Product, lifecycle and Clinical claims roadmaps) in close cooperation with global markets (supported by Market Intelligence) As a Senior Global Product Manager, you will be part of a team that is revitalizing our portfolio of Patient Interface products – creating pivotal change for the Sleep & Respiratory Care business.
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Maintains the Pharmacy area in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise/supplies, identifying shrink and damages, and ensuring a safe work environment.
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Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.
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adjuster claims jobs in Burlington, MA
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