- Westat (Rockville, MD)
- …projects and value-based care topics for Federal agencies such as the Centers for Medicare & Medicaid Services ( CMS ) is required. This position is eligible for ... **27513BR** **Job Title:** Principal Research Associate - Economist - CMS **Location:** MD - Rockville **Job Description:** Westat is an employee-owned corporation… more
- 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 (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
- 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
- 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
- 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
- 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
- CVS Health (Southfield, 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
- 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
- AdventHealth (Altamonte Springs, FL)
- …+ Create core reporting dashboards summarizing and trending all aspects of Medicare business, CMS Revenue, Enrollment, Risk Adjustment, cost trend, and ... **Senior Medicare Data & Finance Analyst** **Location:** Virtual **All...+ Solicit and incorporates input from peers, customers, and management for process improvements + Apply knowledge of new… more
- AmeriHealth Caritas (Newtown Square, PA)
- …adequacy and support provider network expansion. + Monitor and track Centers for Medicare and Medicaid Services ( CMS ) and state-level regulatory requirements and ... **Education & Experience:** + 3 to 5 years of experience in Medicare /Medicaid vendor account/contract management and operations. + Bachelor's Degree required.… more
- The Cigna Group (Morris Plains, NJ)
- …requires the following core skills to be successful: + Executive Presence + Medicare Expertise + Communication + Relationship Management + Strong strategic ... **POSITION SUMMARY** The Medicare Client Strategy Senior Manager is accountable for...as work cross functionally with research, sales and account management , client and patient services and other functional areas… more
- USAA (Tampa, FL)
- …implementation of business processes. This role will involve execution of any Issue Management matters for Medicare Supplement claim issues. As business process ... settlements + Knowledge of process, procedures and requirements related to Centers for Medicare & Medicare Services ( CMS ) + Extensive experience working… more
- Humana (Columbus, OH)
- …or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and determinations whether services… more
- The Cigna Group (Philadelphia, PA)
- …to management and associates. **Responsibilities:** Primary focus areas are Medicare pricing and CMS bid and supporting documentation development, support ... limited to: medical expense analyses and projections, financial forecasts, Medicare Part C bid development, regulatory ( CMS )...life. We guide our customers through the health care system , empowering them with the information and insight they… more
- Vanderbilt University Medical Center (Nashville, TN)
- …and audit results. Monitors new regulatory and/or billing requirement changes from Medicare Administrative Carriers and CMS websites and published guidance. ... retrieval and manipulation Knowledge of Third-Party Contracting Strategies Knowledge of Chargemaster Management and Pricing Strategies Knowledge of CMS and state… 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
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... for providers and medical groups. + Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews. + Travel to provider… more