- Medical Mutual of Ohio (OH)
- …reply report review and validating manufacturer labeler code updates in the PBM system . . Supports Medicare Plan Finder processes for validating DestinationRx ... a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare & Medicaid Services ( CMS ) guidelines, preferably Part D. . Certified… more
- Elevance Health (Smithfield, RI)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... **Audit & Reimbursement Senior -** ** Medicare Cost Report Audit** **Locations:** _This is a...and audits. + Review of complex exception requests and CMS change requests. + Perform supervisory review of workload… more
- CareOregon (Portland, OR)
- … Encounter Data Analyst leads the process for the end-to-end Encounter Data Processing System (EDPS) data flow and works within CMS guidelines for acceptable ... the complete and accurate submission of encounter data to CMS . + Monitor and track Medicare encounter...file reconciliations. + Minimum 3 years' healthcare, claims, data management , EDI experience Preferred + Experience with Medicare… more
- Elevance Health (Columbus, OH)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... **Audit & Reimbursement III- Medicare Cost Report Audit** _This is a United...findings in accordance with Government Auditing Standards (GAS) and CMS requirements. + Gain experience with applicable Federal Laws,… more
- Elevance Health (Columbus, OH)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... **Audit & Reimbursement III- Medicare Cost Report Appeals** **Location** : This is...findings in accordance with Government Auditing Standards (GAS) and CMS requirements. + Gain experience with applicable Federal Laws,… more
- The Cigna Group (Bloomfield, CT)
- …position is Customer Service Senior Supervisor, which is a Band 3 Management Career Track Role. **Customer Service Senior Supervisor- Medicare ** The Government ... and/or escalated member/provider issues (CTM complaints) received from The Centers for Medicare and Medicaid Services ( CMS ), Department of Insurance (DOI),… more
- Centene Corporation (Austin, TX)
- …million members. **Position Purpose:** This position will be a member of Medicare & Compliance Senior Leadership, chairs Centene's Medicare Compliance Committee, ... with a commitment to service leadership. + Leading the Medicare Compliance team with a collaborative mindset and demonstrated...that data and other information and materials submitted to CMS are accurate and in compliance with CMS… more
- General Dynamics Information Technology (Fairfax, VA)
- …findings and recommendations to our team and customer, The Centers for Medicare & Medicaid Services ( CMS ). **Responsibilities:** + Lead a cross-functional ... NACI (T1) **Job Family:** Data Analysis **Skills:** Data Analysis,Healthcare Analytics, Medicare , Medicare Advantage,Researching **Experience:** 8 + years of… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services ( CMS ) and company policies and regulations. The ... + AHIP certified + Computer/technology literacy + Compliant with CMS and CPHL policies. + Follow CPHL, CMS...CPHL sites located throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare … more
- Medical Mutual of Ohio (Brooklyn, OH)
- …the product development of the Medicare Advantage. This role supports Medicare product management by evaluating data trend experience, creating data ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans....work on product and benefit design during the annual CMS Bid cycle and act as a key member… more
- PruittHealth (Athens, GA)
- … Medicare /Medicaid and/or nursing community dynamics. * Demonstrate compliance with CMS regulations regarding Medicare Advantage Plans and PruittHealth Code ... special needs plans (DSNPs) 3. Work effectively with sales administration management for as-needed enrollment admin support; 4. Successfully utilize sales closing… more
- UCLA Health (Los Angeles, CA)
- …Guide strategic goals to manage health plan resources effectively and align with broader system initiatives. + File necessary documentation with CMS and DMHC to ... with regulatory agencies and auditors + Strong familiarity with Medicare regulations and CMS expectations or best practices + Additional certifications such as… more
- Centene Corporation (Cheyenne, WY)
- …Master's degree preferred. + 5+ years project implementation, product or program management experience. + Medicare Supplement Benefits (Dental, Vision, Hearing) ... levels, and value by leading the dental, vision and hearing Medicare Product development through strategy development, identify opportunities, plan, organize,… more
- CVS Health (Nashville, TN)
- …+ Ensuring that the relevant information is captured in Customer Relationship Management system (CRM) + Other duties as assigned. **Accountabilities** : ... an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part...and standards with a robust knowledge with respect to CMS and states regulations. + Ability to multitask, and… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …ProAct. Responsibility for the understanding and compliance of benefit designs, system management of formularies, eligibility, claims and payment, ... and/or EGWP programs.** **Scope of Responsibilities:** Provides oversight and management of Medicare Part D/EGWP program. **Job...Medicare Part D/EGWP programs + Ensure compliance with CMS rules and regulations surrounding Medicare Part… more
- CVS Health (Lansing, MI)
- …superior P&L management + Driving financial strength of the Group Medicare business segment while positioning for future profitable growth + Deep engagement with ... manner. **Group Retiree Solutions** (GRS) is a core component of the Aetna Medicare Organization. Our vision is to develop an industry-leading group retiree health… more
- USAA (San Antonio, TX)
- …implementation of business processes. This role will involve execution of any Issue Management matters for Medicare Supplement claim issues. As business process ... + 5 or more years of experience working with Medicare Supplement and Medicare product management...of process, procedures and requirements related to Centers for Medicare & Medicare Services ( CMS )… more
- Humana (Columbus, OH)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences,… more
- GEHA (Lee's Summit, MO)
- …a personalized customer experience, sustained by a nimble and efficient organization. The Medicare Part D Performance Management Specialist will report to the ... Serves as a subject matter expert to Centers for Medicare & Medicaid Services ( CMS ) Part D...Monitor key performance indicators in clinical, operational, and vendor management areas to proactively inform leadership and departmental business… more
- PruittHealth (Moultrie, GA)
- … Medicare /Medicaid and/or nursing community dynamics. * Demonstrate compliance with CMS regulations regarding Medicare Advantage Plans and PruittHealth Code ... special needs plans (DSNPs) 3. Work effectively with sales administration management for as-needed enrollment admin support. 4. Successfully utilize sales closing… more