- 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
- Medical Mutual of Ohio (OH)
- …required. + Provides sales/marketing content material review and pre-approval prior to CMS filing, and agent job aid and Medicare event pre-approval for our ... for audit purposes. + Provides on-site, face-to-face agent oversight of Centers for Medicare /Medicaid Services ( CMS ) filed events - both informal and formal… 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** **_Locations:_** _This is a...findings in accordance with Government Auditing Standards (GAS) and CMS requirements. + Gain experience with applicable Federal Laws,… more
- Point32Health (Canton, MA)
- …ensuring that Plan Benefit Packages (PBPs) are reviewed and ready for bid filing in CMS ' Health Plan Management System (HPMS). The Senior Manager will also ... annual bid/rate and related filings, new benefit implementation, and product/vendor management processes. The Senior Manager will support annual assessment of new… more
- Centene Corporation (Austin, TX)
- …contract language. + Identify, evaluate, and analyze the impact of CMS and Medicare regulatory issues and advise management concerning impact. + Report all ... with federal and state legal and regulatory requirements as it relates to Medicare compliance and HPMS/ CMS regulations. + Oversee and monitor various of… 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
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …Accounting Billing System + Knowledge of working F .I.S.S.(Florida Institutional Shared System ) in order to resolve Medicare claim issues + Keep abreast of ... medical necessity + Ability to navigate and fully utilize Medicare Fiscal Intermediary (Palmetto GBA) and CMS ...inform ation contained within the Patient Accounting and Billing system to make decisions on how to proceed with… 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
- Abt Global Inc. (Rockville, MD)
- …care claims data to play key technical roles on projects for the Centers for Medicare and Medicaid Services ( CMS ). As a member of the Research, Monitoring, and ... add a talented researcher to its team of experts conducting policy-relevant Medicare and Medicaid research and evaluation. The successful candidate will leverage… more
- Library of Congress (Washington, DC)
- …and abuse); knowledge of the regulation of Medicare by the Centers for Medicare & Medicaid Services ( CMS ); and an ability to analyze federal policy issues ... analyst will need to be familiar with federal regulatory policy for Medicare ; relevant CMS regulations for the regulation of Part B premiums, financing, end… more
- CareOregon (Portland, OR)
- …and accurate monitoring and reporting of performance against metrics. + Ensures the Medicare program meets all CMS , OHA, contractual and other requirements. + ... Skills and Abilities Required Knowledge + Advanced knowledge of Medicare , the Medicare Advantage program and CMS + Strong understanding of managed care and… more
- Wider Circle (Los Angeles, CA)
- …Scope of Appointment, the presentation of the product, sales conversion, and relationship management of a Medicare beneficiary * Daily tasks include completing a ... a fast-growing boutique insurance agency focused on helping people understand their Medicare Benefits. We work with underserved populations to help them navigate … more
- Providence (Beaverton, OR)
- …obligations to CMS as well as our obligations to our Medicare members. Non-compliance can result in legal action, financial sanctions and/or financial ... and retain the best people, we must empower them.** ** Medicare Advantage is a strategic growth strategy for PH&S...work teams, external contracted entities, preparation and response to CMS audits, coordination of CMS filing required… more
- CVS Health (Lansing, MI)
- …limited to: * Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals and applicable Medicaid rules including risk ... business, analytical and communication skills to support, manage and develop Medicare and Medicaid compliance programs and processes that promote compliant and… more
- Molina Healthcare (Columbus, OH)
- **Job Summary** As the leader for Molina's Medicare Advantage product (Non-Dual), this position has P&L, business strategy, sales distribution and provider network ... Foster highly productive working relationships that enable close collaboration with Molina Medicare Segment Leadership Team as well as Market Plan Presidents key… more
- CVS Health (Hartford, CT)
- …to make health care more personal, convenient and affordable. As the Senior Manager, Medicare Duals Member Experience Project Management within the Medicare ... healthcare journey. **Fundamental Position Components:** + Provide direct leadership of the Medicare Member Advisory program and to ensure the collected feedback and… more
- Humana (Harrisburg, PA)
- …our caring community and help us put health first** Are you passionate about the Medicare population, looking for a role in management with the ability to ... self-driven individuals to join our team. Our Senior Manager, Medicare Sales motivates and drives a team of ...and provide creative solutions to increase sales while following CMS guidelines. This role also involves cultivating, maintaining, and… more
- BayCare Health System (Clearwater, FL)
- …to work! BayCarePlus Medicare Advantage Plans (https://baycare.org/ medicare -advantage-plans) **Facility:** BayCare Health System , Sales-BHS **Location:** ... dignity, respect, responsibility and clinical excellence. **Summary:** + Health Care Advisors/ Medicare Sales Agents are the face of BayCare Health Plans and are… more
- UCLA Health (Los Angeles, CA)
- …combination of education and experience required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 ... organization. Elevate the operational effectiveness of a complex health system . Take your professional expertise to the next level....at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in… more
- Community Health Systems (Oro Valley, AZ)
- **Job Summary** The Medicare IRF PAI Coordinator is responsible for ensuring documentation in patient's medical records are accurate, detailed, and supports all ... CMS guidelines for admission and reimbursement for the admission...any scoring discrepancies. + Generates and transmits reports to CMS using UDS. + Analyzes medical record coding for… more