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The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues.
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Work with Director of Annual Giving to develop opportunities to leverage alumni volunteers for phone campaigns, direct mail appeals and e-solicitation materials with tailored message for young alumni.
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Supervises and assists staff liaisons to the Planning Board (PB), Zoning Board of Appeals (ZBA), Urban Design Commission (UDC), and/or Historic Preservation Commission (HPC), as necessary. Supervises and assists staff liaisons to the Planning Board (PB), Zoning Board of Appeals (ZBA), Urban Design Commission (UDC), and/or Historic Preservation Commission (HPC), as necessary.
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Clinician will be either credentialed with United Healthcare, Cigna, BCBS, Alliance Medicaid, Partners Medicaid, Amerihealth, WellCare, Carolina Complete Health, and/or Healthy Blue or willing to pursue in order to provide care to our client population.
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Patients presenting for services, by appointment or walk-in, will be screened for eligibility and offered enrollment assistance to secure insurance coverage through MassHealth, Out of State Medicaid, HSN, or BMC’s Charity Care Program.
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
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MMM Holdings, LLC is a company that provides Medicare Advantage and Medicaid plans in Puerto Rico. Currently, MMM Holdings, LLC operates in Puerto Rico under Elevance Health, Inc. a leading health company dedicated to improving the quality of life of communities in the United States.
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The Day Habilitation Service Manager (DHSM) ensures documentation and delivery of services in compliance with Medicaid regulations, CARF, and Bay Cove standards. Serve as Day Habilitation Service Manager (Medicaid regulatory title.
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Must have Tools: Selenium, Client Load Runner, TOAD for Oracle 12.6, Python, Oracle SQL Developer 18.2, PL/SQL, UNIX, AWS, FileZilla, Microsoft Visio, WinSCP, Java, MS Office, Atlassian JIRA, Putty, COGNOS.· Prior experience working in healthcare or government setting with a strong knowledge base in healthcare insurance principles, eligibility, and Medicaid Management Information System (MMIS.
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The Deputy Chief Counsel is responsible for the leadership, support, training and oversight of private bar panels in criminal, sexually dangerous person and sex offender registry cases, and in appeals and post-conviction cases related to those matters.
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The agency provides representation in criminal, delinquency, youthful offender, child welfare, guardianship, mental health, sexually dangerous person, and sex offender registry cases, as well as in appeals and post-conviction and post-judgment proceedings related to those matters.
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Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals.
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Perform administrative record keeping, including documentation of services (may include Medicaid documentation) to be reviewed by the supervising speech-language pathologist. Speech-Language Pathology Assistant license as set forth by the state of Oregon Board of Examiners for Speech-Language Pathology and Audiology.
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They will coordinate with the Director of Annual Giving on the creation and segmentation of direct mail and email appeals as well as have an input to all stewardship efforts regarding affinity groups.
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Acceptable results of annual credentialing and CORI reviews and OIG Medicaid Fraud checks will be required of the Housing Placement Specialist. Additionally, an annual CORI review and OIG Medicaid Fraud checks will be conducted for the Housing Placement Specialist.
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appeals medicaid jobs in Cambridge, MA
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