Receiving Clerk NucorReceiving ClerkJackson, WISUMMARY: The Receiving Clerk is responsible for deliveries, verifying shipment records, accepting shipments and distributing materials and parts to the appropriate location ensuring accuracy within the provided lead times. Open shipments; confirm that product quality and quantity are per the purchase order; stage materials and parts; segregate any non-conforming or damaged items.
NewAssociate Specialist, Patient Access Ensemble Health PartnersAssociate Specialist, Patient AccessGreen Bay, WI$17–$18.15Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.
NewPatient Access Specialist - Sheboygan Part Time Ensemble Health PartnersPatient Access Specialist - Sheboygan Part TimeSheboygan, WI$17–$18.15Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.
NewPatient Access Specialist - Part-time Ensemble Health PartnersPatient Access Specialist - Part-timeGreen Bay, WI$17–$18.15Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.
Medical Coding Education Associate Elevance Health IncMedical Coding Education AssociateWaukesha, WI$58,000–$91,350 / yearRequires current, valid, active, and unrestrictive RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Cert Coding Specialist and/or CPC Cert Professional Coder. Provide providers with comprehensive feedback on current year coding guidelines and industry expertise, facilitated through phone and email correspondences to ensure that provider understands coding and documentation guidelines for the applicable concept(s).
Medical Coding & Prior Authorization Specialist Crossing Rivers HealthMedical Coding & Prior Authorization SpecialistWIAssigns diagnoses, procedural/treatment, professional billing codes for all patient type encounters (Clinic, Center for Specialty Care, Emergency, Urgent Care, Outpatient Services, Lab, Imaging, Physical/Occupational/Speech Therapy, Surgery, Observation/Inpatient, Obstetrics) utilizing ICD-10-CM, ICD-10-PCS or CPT guidelines. This position is responsible for coding all/assigned encounter types; reviewing and correcting coding related denials and managing prior authorization processes for specialty services, surgical procedures, therapies and imaging.
NewMedical Coding Systems Analyst QuartzMedical Coding Systems AnalystMadison, Wisconsin$72,500–$90,600 / yearFull timeSelf-motivated, organized, with the ability to work independently to successfully investigate complex issues, and manage multiple tasks simultaneously and complete timely. Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.
CODING EDUCATOR & AUDITOR Froedtert & The Medical College of WisconsinCODING EDUCATOR & AUDITORMANITOWOC, WI$24.05–$38.48 / hourShift Details: Holidays: Weekends: Job Summary: Responsible for developing and conducting coding and billing training programs for a multi-specialty physician practice and coding support staff while remaining compliant with government and third party payer regulations and guidelines. This role will work collaboratively with Community Physician professional services providers; Patient Financial Services (Billing & Collections); Charge Capture; Epic Charge Process; Clinic Operations; Clinical Compliance and Health information and Management staff.
Manager of Coding Mercy Health System CorporationManager of CodingWisconsinPartnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals. Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.
NewCoding Systems Analyst Unity Health InsuranceCoding Systems AnalystMadison, WI$72,500–$90,600 / yearSelf-motivated, organized, with the ability to work independently to successfully investigate complex issues, and manage multiple tasks simultaneously and complete timely. Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.
Medical Billing Assistant - Entry Level VitalsearchgroupMedical Billing Assistant - Entry LevelMilwaukee, WisconsinThe Medical Billing Assistant will help prepare and review insurance claims, assist with basic billing and coding tasks, update patient and insurance information, and support the administrative workflows that help keep clinical operations running smoothly. This person should be comfortable learning billing and coding processes, communicating with patients professionally, and maintaining accuracy when working with claims, records, and confidential information.
Medical Billing Specialist Mi Familia & Summit Home Health and HospiceMedical Billing SpecialistPlatteville, WIRemote$58,000–$74,000The Medical Billing Specialist will be responsible for processing medical claims, managing insurance reimbursements, resolving billing issues, and ensuring accurate and timely revenue cycle operations. Summit Home Health & Hospice is a Texas-based healthcare organization dedicated to enhancing the lives of patients and families through compassionate home health and hospice services.
NewPhysician Revenue and Billing Compliance Coordinator ThedaCare IncPhysician Revenue and Billing Compliance CoordinatorNeenah, WIThis role is the subject matter expert in regulatory and payer policies and is responsible to implement regulatory and payer policy changes, investigate billing requirements needed to support new clinical services, manage and mitigate escalated payer denials, perform timely resolution of payer audits, and design sustainable charge capture and reconciliation protocols. Summary: The Physician Revenue and Billing Compliance Coordinator partners with clinical, revenue cycle, compliance and finance departments to effectively monitor, communicate, and implement compliant billing practices.
Medical Coding Specialist II - Ortho/Rehab with Multi Spec University of Wisconsin Hospitals and Clinics AuthorityMedical Coding Specialist II - Ortho/Rehab with Multi SpecMiddleton, WIRemoteMaintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National CoveraDocuments (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers. We are seeking a Medical Coding Specialist II to: Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes.
Medical Coding Specialist II - Profee Radiology University of Wisconsin Hospitals and Clinics AuthorityMedical Coding Specialist II - Profee RadiologyMiddleton, WIRemoteMaintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers. We are seeking a Medical Coding Specialist II to: Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes.
NewLong-Term Care (LTC) Medical Coding Policy SME - Remote, Wisconsin Gainwell Technologies LLCLong-Term Care (LTC) Medical Coding Policy SME - Remote, WisconsinWIRemote$64,500–$85,000 / yearThis role is responsible for reviewing and evaluating CPT, HCPCS, and ICD-10 coding updates, supporting MMIS-related initiatives, researching complex policy and coding questions, and partnering with internal and external stakeholders to ensure coding guidance, system configuration, and reimbursement policies remain accurate and compliant. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
PROFESSIONAL FEE CODER - CODING Aspirus IncPROFESSIONAL FEE CODER - CODINGWausau, WIKnowledge of coding principles normally acquired through an Associate''s Degree in Health Information Management, Healthcare Business Services, or an equivalent program with emphasis in coding or a minimum of two years coding experience. The health system operates 18 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians.
Instructor, Medical Coding Specialist-Part-Time (Online) Milwaukee Area Technical CollegeInstructor, Medical Coding Specialist-Part-Time (Online)Mequon, WIWorking knowledge of computers and software related to instructional area including MS Office/Google Suite, data systems, mobile technologies, web conference tools, and social networking; and knowledge of, or willing to learn, Blackboard or similar learning management system (LMS) preferred. Reviews professional and hospital inpatient and outpatient medical record documentation and properly identifies and assigns ICD-10-CM, ICD-10 PCS, and CPT-4 codes, DRGs, MS DRGs, Present On Admission (POA) indicators, APCs, and modifiers as well as abstracting these code assignments according to official guidelines.
Profee Surgical Coding Specialist III - REMOTE Children's Hospital and Health SystemProfee Surgical Coding Specialist III - REMOTEWest Allis, WisconsinRemoteone of the following: - N/A, CCS-Certified Coding Specialist - American Health Information Management Association, CCS-P-Certified Coding Specialist Physician Based - American Health Information Management Association, CPC-Certified Professional Coder - American Board of Professional Coders, RHIT-Registered Health Information Technician - American Health Information Management Association. The Profee Surgical Coding Specialist III will work in collaboration with Ancillary or specialty departments/locations/providers to code, review and release charges in a timely manner and to ensure correct coding, billing compliance and complete charge capture.
Coding Specialist II, Psychiatry - Clinical Practice Services The Medical College of WisconsinCoding Specialist II, Psychiatry - Clinical Practice ServicesWisconsinResolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.
Coding Specialist II The Medical College of WisconsinCoding Specialist IIMilwaukee, WisconsinResolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.
Coding Documentation Education Specialist Gundersen Health SystemCoding Documentation Education SpecialistWIWith over 4,500 dedicated nurses and providers, we are committed to delivering primary, specialty and emergency care, along with innovative medical education programs. Our extensive network includes 11 hospitals and more than 100 clinics, serving 67 cities and rural communities across Wisconsin, Iowa, Minnesota and Michigan's Upper Peninsula.
Profee Surgical Coding Specialist III - REMOTE Children's WisconsinProfee Surgical Coding Specialist III - REMOTEWest Allis, WIRemoteCertifications/Licenses: one of the following: - N/A, CCS-Certified Coding Specialist - American Health Information Management Association, CCS-P-Certified Coding Specialist Physician Based - American Health Information Management Association, CPC-Certified Professional Coder - American Board of Professional Coders, RHIT-Registered Health Information Technician - American Health Information Management Association. The Profee Surgical Coding Specialist III (Pediatric Urology and ENT) will work in collaboration with Ancillary or specialty departments/locations/providers to code, review and release charges in a timely manner and to ensure correct coding, billing compliance and complete charge capture.
NewCoding Specialist - Hospital Services Gundersen Health SystemCoding Specialist - Hospital ServicesWIEmplify Health, a partnership of Bellin Health and Gundersen Health System, is a leading not-for-profit, patient-centered healthcare network based in Green Bay and La Crosse, Wisconsin. We are seeking a detail‑oriented Coding Specialist to support accurate outpatient hospital coding and ensure compliance with ICD‑10‑CM, CPT, and HCPCS guidelines.
FACILITY INPATIENT CODER - CODING Aspirus IncFACILITY INPATIENT CODER - CODINGWausau, WIRemoteThe health system operates 19 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians. Knowledge of medical record and coding practices normally acquired through completion of an Bachelor or Associate Degree in Health Information Technology or Coding, or an equivalent program with emphasis in coding required.
Professional Coding Lead-Oncology Advocate Aurora Health IncProfessional Coding Lead-OncologyMilwaukee, WIRemote$30.70–$46.05 / hourAdvocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: • Compensation • Premium pay such as shift, on call, and more based on a teammates job • Incentive pay for select positions • Opportunity for annual increases based on performance • Benefits and more • Paid Time Off programs • Health and welfare benefits such as medical, dental, vision, life, and • Short- and Long-Term Disability • Flexible Spending Accounts for eligible health care and dependent care expenses • Family benefits such as adoption assistance and paid parental leave • Defined contribution retirement plans with employer match and other financial wellness programs • Educational Assistance Program. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise.
Supervisor Coding - Fiscal Denials University of Wisconsin Hospitals and Clinics AuthoritySupervisor Coding - Fiscal DenialsMiddleton, WI2 years medical coding experience with at least one (1) year in a leadership role (for non-HCC role) or 2 years HCC Risk Adjustment experience with at least one (1) year in a leadership role (for HCC-specific role) Required. Our respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day.
Coding Quality Analyst - Inpatient University of Wisconsin Hospitals and Clinics AuthorityCoding Quality Analyst - InpatientMiddleton, WIRemoteFull timeOur respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. We are seeking a Coding Quality Analyst to: Assess the accuracy and completeness of the coding of inpatient cases by performing retrospective and concurrent audits and to ensure compliance with coding guidelines and regulatory requirements.
Hospital Billing Coordinator Deloitte Touche Tohmatsu LtdHospital Billing CoordinatorWI$50,000–$60,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Coding Auditor ThedaCare IncCoding AuditorAppleton, WIQUALIFICATIONS: • High School diploma or GED preferred • Minimum three years of experience in hospital coding • Minimum two years of experience in clinical medical audit review • Current or obtained within one year of hire - Certified Coding Credential obtained through AHIMA or AAPC, or RHIT (Registered Health Information Technologist/AHIMA), or RHIA (Registered Health Information Administrator/AHIMA). • Minimum certification requirement is one of the following: CCS (Certified Coding Specialist/AHIMA), CPC (Certified Professional Coder/AAPC), CIC (Certified Inpatient Coder/AAPC), or COC (Certified Outpatient Coder/AAPC).
NewCoding Data Quality Auditor CVS Health CorpCoding Data Quality AuditorWI$18.50–$38.82 / hourResponsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures. Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
Billing Specialist OUTREACH COMMUNITY HEALTH CENTERS, INC.Billing SpecialistMilwaukee, WIThe essential functions include, but are not limited to the following: Claims Submission: Ensure all claims are submitted with a goal of zero errors by verifying completeness and accuracy prior to transmission. Outreach Community Health Centers requires employees in certain departments to be fully vaccinated against MMR (Measles, Mumps, Rubella), Varicella (Chickenpox), and Influenza.
Billing Specialist Community Health Systems of WisconsinBilling SpecialistBeloit, WIJOB SUMMARY: Processes insurance; gathers charge information; completes billing process; files insurance claims; performs collection and follow up work. Analyzes patient denials for possible re-submission and reports to Revenue Cycle Manage denial trends.
Compliance Program Manager - Research Billing University of Wisconsin Medical FoundationCompliance Program Manager - Research BillingMiddleton, WIFull timeOur respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. Use independent judgement and apply a comprehensive understanding of regulations and policies in administering processes to ensure they are structured to comply with CMS, FDA, HRSA, and other governmental regulatory requirements related to research billing compliance.
NewEpic Resolute Hospital Billing Associate Analyst Deloitte Touche Tohmatsu LtdEpic Resolute Hospital Billing Associate AnalystMilwaukee, WI$50,000–$60,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Hospital Billing Operator Deloitte Touche Tohmatsu LtdHospital Billing OperatorWI$70,000–$90,000 / yearOur purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs.
Billing Specialist MILWAUKEE HEALTH SERVICES, INC.Billing SpecialistMilwaukee, WIWorking knowledge of insurance payment regulations, including reimbursement, co-insurance, and deductibles, and contractual adjustments (Medicare, Medicaid, managed care, commercial insurance, and workers compensation. The Billing Specialists role focuses on maximizing revenue and cash flow by completing these tasks promptly and efficiently.
New(Remote) Hospital Billing Representative Harris Computer Systems(Remote) Hospital Billing RepresentativeMadison, WIRemote$18–$28 / hourThis role is not focused on backend accounts receivable, collections, denial management, appeals, underpayment recovery, payment posting, refunds, aging reports, EOB review, patient calls, or patient balance follow up. MEDHOST, a division of Harris; is seeking a Hospital Billing Representative who will support front end hospital billing and clean claim submission for insurance payers, including Medicare, Medicaid, Blue Cross, commercial payers, and other government entities.
Skilled Nursing Billing Supervisor Grace Lutheran CommunitiesSkilled Nursing Billing SupervisorAltoona, Wisconsin100% of work day is spent inside; sits 85% of work day, frequently at keyboard/terminal; stands 5% of work day, walks 10% of work day. Communicate verbally and/or in writing to residents/clients, families, staff, outside business agencies/contacts.
Coding Specialist III (Inpatient) - Part time - REMOTE Children's Hospital and Health SystemCoding Specialist III (Inpatient) - Part time - REMOTEWest Allis, WisconsinRemoteWe provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. + one of the following: - N/A, CCS-Certified Coding Specialist - American Health Information Management Association, RHIA-Registered Health Information Administrator - American Health Information Management Association, RHIT-Registered Health Information Technician - American Health Information Management Association.
Supervisor - Inpatient Coding University of Wisconsin Hospitals and Clinics AuthoritySupervisor - Inpatient CodingMiddleton, WIFull time2 years medical coding experience with at least one (1) year in a leadership role (for non-HCC role) or 2 years HCC Risk Adjustment experience with at least one (1) year in a leadership role (for HCC-specific role) Required. Our respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day.
Coding Specialist III (Inpatient) - Part time - REMOTE Children's WisconsinCoding Specialist III (Inpatient) - Part time - REMOTEWest Allis, WIRemoteCertifications/Licenses: one of the following: - N/A, CCS-Certified Coding Specialist - American Health Information Management Association, RHIA-Registered Health Information Administrator - American Health Information Management Association, RHIT-Registered Health Information Technician - American Health Information Management Association. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers.
Medical Office Front Desk Receptionist ATI Physical TherapyMedical Office Front Desk ReceptionistPewaukee, WisconsinFull timeQualifications: Minimum Education Required: • High School diploma or equivalent Preferred: • Minimum Experience Required: • 1 or more years in an administrative position • Preferred: • Previous health care office experience • Previous medical billing and coding • Knowledge of benefit verification and authorization Knowledge Skills and Abilities • The ability to communicate effectively and professionally • Proficient with Microsoft Office Suite • Bilingual language skills in some clinics preferred Virtual Employee?: Overview: Leverage your healthcare office experience and expertise in billing, coding, and insurance authorizations in a front office role where you’ll support patient intake, scheduling, and accurate claims—while serving as a key point of contact for clinic operations.
NewMedical Office Front Desk Receptionist ATI Physical Therapy IncMedical Office Front Desk ReceptionistWILeverage your healthcare office experience and expertise in billing, coding, and insurance authorizations in a front office role where you'll support patient intake, scheduling, and accurate claims-while serving as a key point of contact for clinic operations. Individual is responsible for the clinical administrative functions of patient intake, scheduling, and registration, and clinic-based activities required to ensure accurate billing and claims.
Medical Laboratory Scientist or Medical Laboratory Technician (Part Time) Southwest HealthMedical Laboratory Scientist or Medical Laboratory Technician (Part Time)Platteville, WisconsinPerforms clerical duties to include: Ensuring patients are properly registered, scanning reports into the patient’s chart, filing reports, answering phone calls to assist patients, nurses and physicians, reconciliation of billing, faxing results, preparing specimens to be sent out to reference laboratories, word processing and stocking supplies. Performs patient testing which includes instrument startup, maintenance (if applicable daily, weekly, monthly), instrument repair (including phone/modem work with technical specialist), quality control, calibration, troubleshooting, record keeping and patient reporting in the departments noted below: Chemistry.
NewSupervisor Clinic Operations - Medical Specialty Advocate Health and Hospitals CorporationSupervisor Clinic Operations - Medical SpecialtyWaukesha, WisconsinHeadquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care.
Supervisor Clinic Operations - Nursing Medical Group Advocate Aurora Health IncSupervisor Clinic Operations - Nursing Medical GroupWI$35.50–$53.25 / hourHeadquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care.
NewHome Medical Equipment Specialist, Retail ThedaCare IncHome Medical Equipment Specialist, RetailWIKEY ACCOUNTABILITIES: Provides exceptional customer service either face-to-face or telephonically with customers and their family members, referrals sources, payer's, and our internal customers to meet the customer's home medical equipment needs. Analyzes data to ensure accuracy with insurance resources and guidelines, regulatory and reimbursement manual and criteria, HCPC and ICD-10 coding manuals, provider directories, and other online resources to ensure accurate billing and reimbursement.
Appeals and Grievances - RN, Consultant (MediCare) Blue Cross and Blue Shield AssociationAppeals and Grievances - RN, Consultant (MediCare)Milwaukee, WIIn this role, you will: Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and Med-Cal, including dual-eligibility products. In this role you will be leading a team of nurses who will be responsible for performing first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, and nationally recognized sources such as MCG, NCCN, and ACOG.
Specialist, Appeals & Grievances (Must live in TX and Medicaid experience) Molina Healthcare IncSpecialist, Appeals & Grievances (Must live in TX and Medicaid experience)Kenosha, WIRequests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met.