- Centene Corporation (Raleigh, NC)
- …home anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of regulatory ... requirements associated with the Medicare materials and sales compliance . Participates in the ongoing oversight, analysis, review, and approval of all… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Medicare Quality Specialist , Pharmacy will assist the Medicare Adherence Pharmacists Team to improve Medicare Star Ratings and CAHPS by ... collaboration with internal and external partners, assisting with the administration of Medicare programs, and other projects assigned to support the Medicare … more
- CVS Health (Nashville, TN)
- …sales talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist . The position will be a part of a ... specialized team who will focus on educating existing Medicare members on available plan offerings to help meet...selling applicable products to existing members. + Maintaining high compliance commitment and standards with a robust knowledge with… more
- PruittHealth (Norcross, GA)
- …with members of own and other teams to communicate effectively and ensure compliance with cross-team responsibilities. 17. Carries out all duties with a "Commitment ... to Caring" attitude in accordance with PruittHealth's mission, vision, and philosophy. **KNOWLEDGE, SKILLS, ABILITIES:** * In-depth knowledge of various billing documentation requirements, the patient accounting system, and various data entry codes to ensure… more
- The Cigna Group (Bluffton, SC)
- …5+ years of experience working with Medicare Advantage, Medicare -Medicaid. Plan (Dual-Eligible) and/or Medicaid. **Certified Coding Specialist required.** ... Responsible for Part C audit activities for the Cigna Compliance Department, with particular emphasis on Coding, Risk Adjustment and Coding Decisions. Collaborates… more
- Lowe's (Charlotte, NC)
- …treatment to an appropriate resolution. Apply medical treatment guidelines for future Medicare -covered expenses. The candidate will work directly for a Fortune 100 ... caseload of 65 including review of claims identified for Medicare Set-Aside. **What you will do** + Manage an...Rehabilitation Registered Nurse + CDMS - Certified Disability Management Specialist + COHN - Certified Occupational Health Nurse or… more
- Medical Mutual of Ohio (OH)
- …group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Ensures compliance with all statutory, ... accreditation, or compliance . . Experience in health plan government programs ( Medicare , Medicaid) a plus. . Strong knowledge of health insurance operations. .… more
- CareOregon (Portland, OR)
- …for remote positions must reside in Oregon or Washington. Job Title Sr Compliance Specialist Exemption Status Exempt Management Level n/a Direct Reports n/a ... role, but you must reside in Oregon or Washington. Job Summary The Sr Compliance Specialist is responsible for supporting administration of compliance … more
- MyFlorida (Daytona Beach, FL)
- OPS COMPLIANCE SPECIALIST - 67965502 Date: Oct 28, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Agency: Agency for Persons with Disabilities Working Title: OPS COMPLIANCE SPECIALIST - 67965502 Pay Plan: Temp...facility) and nonresidential (adult day training and prevocational) setting compliance with the Centers for Medicare &… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- Trinity Health (Livonia, MI)
- …or all hours being remote. This role is within the Integrity and Compliance department of IAS in the professional services Center of Excellence, providing support ... for the seven elements of an effective compliance program. This role is primarily responsible for the...services which relies on a thorough understanding of the Medicare Physician Fee Schedule, Medicare Claims Processing… more
- Molina Healthcare (Columbus, OH)
- …and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality ... or more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-,… more
- Idaho Division of Human Resources (Boise, ID)
- Contracts & Compliance Program Specialist Posting Begin Date: 2024/10/24 Posting End Date: 2024/11/21 Category: Business Sub Category: Administration Work Type: ... and driving positive outcomes for your community? The role ofContracts & Compliance Program Specialist offers a unique opportunity in supporting Medicaid… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Compliance Resource Specialist (CRS) must have a broad knowledge and understanding of billing compliance as it relates to the Federal ... billing and reimbursement. Reporting to the Director of Hospital Compliance , the responsibilities include routine clinical documentation monitoring, reviews,… more
- Molina Healthcare (West Seattle, WA)
- …any experience in Quality/HEDIS on your application. **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/ QI Compliance contributes to one ... direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. Experience with QUALITY/HEDIS is important for this position.… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …Ensures compliance with federal and state regulations, MA Medicaid, Medicare and Managed Care payment systems. Monitors, consults, and makes effective ... CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and...and MA Medicaid payment methodology. + Extensive knowledge of Medicare reimbursement, compliance , and eligibility. Knowledge, Skills,… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Under direct supervision, ... into the various modules of the Provider Data Management System. Supports compliance with standards set by individual states, federal and accrediting organizations… more
- New York State Civil Service (Thiells, NY)
- …Yes Agency People With Developmental Disabilities, Office for Title Medical Specialist 2 Occupational Category Health Care, Human/Social Services Salary Grade 38 ... on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal...in Canada AND meet the other requirements for Medical Specialist 1 or 2, you are also eligible if… more
- Louisiana Department of State Civil Service (LA)
- …from Medical Certification Specialist 2 by the absence of Centers for Medicare and Medicaid Services certification and by the level of independence exercised in ... and procedures, administration and quality of services to determine the extent of compliance with the state licensure standards and Medicare and Medicaid… more
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