- CVS Health (Southfield, MI)
- …individual will work independently, as well as collaboratively, with internal senior level Medicare compliance and business teams that operate MMP and DSNP ... the CVS Code of Conduct * Maintains current working knowledge and expertise in Medicare Compliance , Medicaid Compliance and State regulations in support of… more
- Elevance Health (Atlanta, GA)
- …Plan, design, develop and lead activities to ensure an effective Compliance program. + Oversees programs for multiple departments/functions with numerous ... a BA/BS and a minimum of 10 years of healthcare, regulatory, ethics, compliance , or privacy experience, including a minimum of 8 years of management experience;… more
- Humana (Columbus, OH)
- …of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... Oncology or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid,… more
- USAA (Tampa, FL)
- …working Medicare / Medicare Supplement and products + Working knowledge of Medicare State and Federal Regulations + Working knowledge of Medicare ... currently seeking a dedicated **Business Process Owner Senior** that will support Medicare Supplement Claims for USAA Life Company Claims Operations. This employee… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal , state, and local ... by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations. The Medicare … more
- CVS Health (Nashville, TN)
- …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
- Providence (WA)
- …to optimize performance + Analyzing and interpreting regulatory guidance to ensure compliance with Medicare Advantage bid requirements + Collaborating with ... empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing and maintaining actuarial… more
- AmeriHealth Caritas (Newtown Square, PA)
- …within Medicare as well as throughout the enterprise to represent Medicare Medical Management interests. + Responsible for periodic review for adequacy ... Operations, Medicare ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 37990 **Job Brief** Bachelor's degree in healthcare related… more
- Vanderbilt University Medical Center (Nashville, TN)
- …of regulatory requirements pertaining to critical revenue cycle functions to promote compliance with federal and state regulations and organizational policies. ... to promote compliant actions regarding regulatory guidance and audits. Regulatory Compliance (Intermediate) - Demonstrates solid knowledge of federal and… more
- VNS Health (Manhattan, NY)
- …of polices concerning medical services for Health Plan members.* Ensures compliance with relevant and applicable federal , state and local laws and ... requiredPrior experience in geriatric medicine preferredPrior experience in a Medical Services Organization preferredDemonstrated strong knowledge of Medicare … more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice ... appeals. The Corporate Medical Director works on problems of diverse scope and...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Trinity Health (Farmington Hills, MI)
- …in Microsoft Office, including Outlook, Word, PowerPoint, and Excel. **Experience performing hospital medical claims follow-up with the Medicare and Medicare ... by the supervisor. Maintains a working knowledge of applicable Federal , State, and local laws and regulations, Trinity Health's...and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as… more
- Prime Healthcare (Redding, CA)
- …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/182560/sr- medicare -medicaid-biller-collector/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityShasta Regional Medical Center… more
- CVS Health (Carson City, NV)
- …for ensuring broker adherence to all CMS and Aetna guidelines by monitoring compliance with state, federal , and health plan regulatory requirements. - Maintains ... Candidates will sit in the Las Vegas Nevada area** Aetna is looking for a Medicare Sales Broker Manager to join the Nevada sales team that drives and achieves sales… more
- The Cigna Group (Sunrise, FL)
- …or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage requiredAbility to apply ... conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance Enablement Lead Analyst's responsibilities include: +… more
- The Cigna Group (Nashville, TN)
- …about the role:** **SUMMARY:** Responsible for the execution of the Cigna Medicare strategy for local topline sales agencies, directly contracted agents, and broker ... market goals . Adheres to and maintains current understanding of compliance requirements and organizational policies & procedures, marketing guidelines and broker… more
- Humana (Columbus, OH)
- …growth. Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Begins ... improving consumer experiences **Preferred Qualifications** + Pricing Experience + Medicare Advantage Experience **Scheduled Weekly Hours** 40 **Pay Range** The… more
- UCLA Health (Los Angeles, CA)
- …this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running processes/jobs ... required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter… more
- The Cigna Group (Bloomfield, CT)
- … medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts. **Essential ... necessity of services. + Provide notification of decisions in accordance with compliance guidelines. + Coordinate with Medical Directors when services do not… more
- PruittHealth (Norcross, GA)
- …agreement objectives. 12. Follows all PruittHealth policies and procedures, state and federal laws and regulations and report violations and potential issues to ... 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… more