- Centene Corporation (Austin, TX)
- …regarding new guidance from federal and state regulators ensuring that all Medicare Compliance policies and procedures are reviewed annually and revised, as ... member of Medicare & Compliance Senior Leadership, chairs Centene's Medicare Compliance Committee, attends meetings of the Enterprise Compliance … more
- Carle (Urbana, IL)
- Medicare Compliance Analyst - HYBRID +...a veteran, and basis of disability or any other federal , state or local protected class. Carle Health participates ... No Email a Friend Save Save Apply Now Position Summary: The Medicare Compliance Analyst is responsible for understanding, researching, interpreting,… more
- 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
- Banner Health (AR)
- …accordingly in a timely fashion. + Working in start-up environment + Medicare Advantage Compliance training, audits, regulations, and manuals. + Reviewing ... knowledge of laws and regulations pertaining to health care, regulatory compliance , Medicare /Medicaid and/or financial reimbursement systems. Must possess strong… more
- The Cigna Group (Bluffton, SC)
- Responsible for Part C audit activities for the Cigna Compliance Department, with particular emphasis on Coding, Risk Adjustment and Coding Decisions. Collaborates ... with Cigna Compliance colleagues and business partners to drive process improvements,...industry changes and/or trends including but not limited to Federal Risk Adjustment cases;*Researches guidelines to ensure Cigna coding… more
- 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...related field required. + Some experience in State or Federal managed care compliance and project coordination… more
- CVS Health (Boston, MA)
- …Part B end-to-end claims processing. The Coordinator will assist in ensuring CVS compliance to Centers for Medicare and Medicaid (CMS) requirements, resulting in ... Part B Team in reducing bad debt, eliminating legal risk and ensuring compliance to all federal /state requirements and CVS Health obligations. In this role,… 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
- Highmark Health (Harrisburg, PA)
- …models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office ... based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies...includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well… more
- The Cigna Group (Bloomfield, CT)
- …representing over 40% of Cigna's total medical cost savings. The **NANPM Medicare Senior Advisor** is responsible for negotiating Medicare Supplemental ... value. This role collaborates with Vendor Segment Leads, Service & Operations, Compliance , Legal, etc. to develop Corrective Action Plans, Business Continuity Plan,… 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
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …and business partners. **Responsibilities** + Provide oversight of operational activities of Medicare Part D/EGWP programs + Ensure compliance with CMS rules ... **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides oversight… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal , state, and local ... including federal and state regulations. + Applies clinical guidelines, Medicare regulations, and study team guidance of conventional care to independently… more
- Amazon (Seattle, WA)
- …Billing, Compliance and Marketing on business initiatives. Knowledge of Medicare Shared Savings Program, Medicare demonstration programs (ACO REACH, ACO ... tech organization, health plan or healthcare related government agency. - Familiarity with Medicare and Medicare Advantage, federal and state Fraud, Waste… more
- Banner Health (AZ)
- …and analysis of results to appropriate management and leadership staff. 6. Ensure compliance with State and Federal laws, rules, regulations and applicable ... (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is...a drug-free work environment. Banner Health complies with applicable federal and state laws and does not discriminate based… more
- Healthfirst (NY)
- **Duties and Responsibilities:** + Monitor experience under Healthfirst's Medicare line of business. + Provide support for annual Medicare bids for all ... analysis and other ad hoc analyses. + Research, evaluate and analyze Medicare market landscape. + Analyze product and segment performance, incorporating both… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Group Medicare Proposal Development Professional reviews solicitations and prepares routine contract review ... requests for proposals (RFPs)/request for renewals (RFRs). The Group Medicare Proposal Development Professional is primarily responsible for reviewing moderate… more
- The Cigna Group (Bloomfield, CT)
- …priority and internal due date based on various regulations which dictate the compliance timeframes. This is a key step as incorrect classification will result in ... matrix partners to ensure accurate and timely processing of Medicare Appeals. + Support the implementation of new process...with criminal histories will be considered for employment in a manner_ _consistent with all federal , state and local… 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...status, genetic information, or any other category protected under federal , state, or local law._ _Qualified applicants with arrest… more