- 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Senior Medicare Compliance Analyst_ **Location:** _OH-Brooklyn_ **Requisition ID:** ... and manages the implementation and daily operation of the Medicare Advantage Compliance Program and all ...Skills and Knowledge** . Working knowledge of Statutory and Federal Regulations that affect our various company products, specifically… more
- Centene Corporation (Austin, TX)
- … federal and state legal and regulatory requirements as it relates to Medicare compliance and HPMS/CMS regulations. + Oversee and monitor various of ... to assist with the development of public policy concerning federal managed care regulations and initiatives. + Represent senior...+ Oversee, administer, and implement various aspects of the Medicare Compliance program. + Provide guidance to… 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 (TX)
- …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
- CareOregon (Portland, OR)
- …express ideas and gain acceptance + Ability to navigate and meet state and federal compliance requirements + Ability to work effectively with diverse individuals ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Sr Vice President, Medicare Department Medicare Administration Exemption Status Exempt Requisition #… more
- CVS Health (New Albany, OH)
- …personal, convenient and affordable. **Position Summary** In support of the Chief Medicare Officer, the candidate has responsibility for ensuring that the local ... Medicare business is compliantly and effectively operating in the...CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member… 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
- Centene Corporation (Jefferson City, MO)
- …+ Provide legal advice and services including advising management concerning state and federal legislation with a focus on Medicare Advantage and Prescription ... and interpretation of specific healthcare policies and regulations with a focus on Medicare . + Provides legal advice to Centene entities to define and develop… more
- Cleveland Clinic (Cleveland, OH)
- …team, patient financial services, clinical research billing office, IRB, and research compliance related to Medicare coverage analysis issues and determinations. ... coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy (CTP). + Ensure research billing...experience (10 years' experience total). + Knowledge of billing compliance and Medicare regulations. + Excellent oral… more
- Providence (OR)
- …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
- 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 ... The Medicare Coverage Analyst (MCA) is responsible for reviewing...which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies… more
- RWJBarnabas Health (Oceanport, NJ)
- …and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines. + Critically analyzes each Medicare inpatient medical record to ... sustain an excellent organizational average accuracy rate. Adherance to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. **Position Summary** The Federal Employee Program (FEP) is one of the largest CVS Health PBM clients. ... The Medicare Business Analytics - FEP - Sr. Manager provides...are visible to leadership and operational teams to ensure compliance and client profitability. **Required Qualifications** + 5+ years… more
- Molina Healthcare (NY)
- …with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal , state and local regulatory requirements. ... **Job Duties** + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and...between segment, health plans, and shared services to drive compliance and performance objectives as well as provide oversight,… 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
- Healthfirst (NY)
- **Duties & Responsibilities:** + Develops, refines, and executes Medicare telesales strategy, including partnership with Dial America and across the various sales ... with supporting areas (eg, Analytics, Development, etc.) and stakeholders within the Medicare Sales team to define and implement enhancements to tele sales… more
- Humana (Columbus, OH)
- …evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and determinations whether services ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide… 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
- Home Care Now (Clearwater, FL)
- Home Care Now is hiring Registered Nurses for Medicare Admissions & Visits for PER DIEM positions serving patients Pinellas County. Medicare Oasis E and SOC ... the physician's plan of care and orders * Complete Medicare SOC and Oasis E documentation * Follow physicians...Oasis E documentation * Follow physicians orders and ensure compliance with plan of care * Accurately report and… more