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Maintain accurate records and documentation of all Medicaid billing activities, including claim submissions, payments, and appeals. 5 years of experience working in medical billing or revenue cycle management, with a focus on Medicaid billing and reimbursement.
Full-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Legal research and drafting of client correspondence, discovery devices, summations, appeals and appellate briefs. Leading law firm is seeking a Workers Compensation Attorney with 2-7 years of experience.
RemoteExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Experienced in Utilization Management and knowledge of URAC & NCQA standards. Telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned and non-assigned post-acute care (PAC) facilities through collaboration.
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The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines.
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The Clinical Quality Program Manager will participate and/or prepare for regulatory accreditation and contractual audits (including CMS program audits, CMS mock audits, CMS data validation audits, OIG audits, WellSky's NCQA accreditation audits, health plan partner NCQA accreditation audits and health plan partner delegation oversight audits.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights and responsibilities. HCA Healthcare Co-Founder. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding departmental functions.
Part-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Duties include preparing and presenting evidence; preparing for trials; interviewing witnesses; researching legal issues; preparing exhibits; preparing and reviewing journal entries, motions, and orders relating to court proceedings; negotiating with attorneys; filing criminal cases; preparing search warrants; appealing issues with the Kansas State Court and the Kansas Supreme Court; arguing at appellate court; preparing briefs; and, tracing progress of appeals through the courts.
$26.47 - $44.1 an hourFull-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Option to work fully remote or a hybrid schedule in any of their office locations in PA. Professional development and advancement opportunities! File review and legal analysis of workers’ compensation claims.
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Reports to: Regional Human Resources Leader Span of Control: 1 Direct Report JOB RESPONSIBILITIES Developing and Executing HR and Labor Relations Strategies: Effectively lead contract administration, grievance resolutions processes, and leadership coaching to ensure constructive, consistent leadership compliant to the collective bargaining agreement.
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Documents all medical evaluation, diagnoses, procedures, treatments, outcomes, education, referrals and consultations consistent with NCQA, The Joint Commission, state regulatory standards and evidenced-based standards of care.
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The Content Strategist will work with the People Solutions business and Lockton marketing teams to develop, coordinate, and support external and internal content that appeals to U.S. employers and group health plan sponsors, while ensuring consistent message delivery.
ExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Responsible for effective utilization review and proper resource management, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening guidelines, and oversight of clinical denials/appeals.
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Document and initiate prior authorization process and claims appeals. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications.
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Experience in working with Health and Wellness and programs or an understanding of wellness principlesThorough knowledge of NCQA® guidelines and state and federal regulationsIntermediate level knowledge of Milliman guidelines.
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Engages with a broader community, such as internal, external, senior-level, Appeals and Counsel personnel, on topics related to relevant engineering and valuation issues, answering questions from the field, and provides external speakers to expand knowledge.
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