- Point32Health (Canton, MA)
- …product strategies in collaboration with Product Strategy counterparts; and 2) lead key aspects of product implementation and administration processes, including ... design, regulatory requirements, and implementation feasibility. The Senior Manager may also lead some workgroups to help flesh out detailed requirements to support… more
- Ventura County (Ventura, CA)
- …reimbursement for Medi-Cal and/or Medicare and prepares reports; + Serves as lead biller/ specialist to the department; and + Performs other related duties as ... processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare , and general insurance...Claim Source to follow up on accounts. Medical Billing Specialist IV is the lead level class… 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- Regulatory Compliance Quality Audit Specialist Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... 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
- Molina Healthcare (South Florida, FL)
- …Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-, program-, and / or initiative-related direction ... and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality… more
- MetLife (Bridgewater, NJ)
- …Dental Service Organizations. Additionally, they will be responsible for understanding compliance and reporting requirements for Medicare Advantage and ... The Team You Will Join: The EDI Specialist position sits within the Dental product team...areas of improvement or adjustments based on HIPAA regulations, Medicare Advantage, or other state agencies * Ensure solutions… more
- Trinity Health (Newtown, PA)
- …**Description:** Trinity Health, Mid-Atlantic, is looking for an Insurance Verification Specialist to join our team! Employment Type: Full-time Schedule: Tues-Thurs ... Friday - 9:00am-5:30pm Saturday - 7:30am-4:00pm The Insurance Verification Specialist is responsible for obtaining and verifying accurate insurance information,… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Elderly Waiver Clinical Policy Specialist ** **Job Class: Human Services Program Representative 2** **Agency: Human Services Department** + **Job ... and training and development opportunities. The Elderly Waiver Clinical Policy Specialist will coordinate all legislative, policy, service delivery, evaluation, and … more
- University of Washington (Seattle, WA)
- …+ May perform the work of Financial Access Specialists, Financial Access Specialist Lead . **REQUIRED POSITION QUALIFICATIONS** + Bachelor's Degree in related ... Medicine and Pathology** has an outstanding opportunity for a **Financial Access Specialist Supervisor** . **WORK SCHEDULE** + 100% FTE (40 hours per week)… more
- HCA Healthcare (Nashville, TN)
- …invested over 156,000 hours volunteering in our communities. As an Inpatient Coding Editor Specialist with Work from Home you can be a part of an organization that ... We are looking for an enthusiastic Inpatient Coding Editor Specialist to help us reach our goals. Unlock your...with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assigns interim… more
- University of Michigan (Ann Arbor, MI)
- Research Area Specialist Senior/Intermediate Apply Now **How to Apply** A cover letter is required for consideration for this position and must be included as the ... Physical Medicine & Rehabilitation seek a full-time Research Area Specialist to join an exciting and growing research team...records + Perform data quality control + Assist and lead systematic reviews and evidence syntheses of medical literature… more
- Sumitomo Pharma (Greensboro, NC)
- …motivated, and experienced individual for the position of **MSPEC** Portfolio Specialist . The successful candidate will be responsible for compliantly driving ... pharmaceutical environment. **Key Core Competencies** + Significant customer (PCP and specialist ) knowledge and understand the business channels and the business… more
- Trinity Health (Grove City, OH)
- …relation between diagnosis and procedure using CPT and ICD-9 coding to ensure compliance with third party regulations. Understands Medicare , Medicaid and other ... and the patients they serve. **Position Purpose:** + Patient Financial Specialist I; Ensures the collection of accurate and complete registration/admission… more
- CenterLight Health System (NY)
- …departmental standard operating procedures and policies and procedures. Ensure to maintain compliance with Medicare , Medicaid, and PACE marketing regulations. + ... JOB PURPOSE: The Community Outreach Specialist will conduct sales and networking to drive Program of All-inclusive Care for the Elderly (PACE) growth through… more
- Trinity Health (Troy, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Provider Contract Specialist - Eddy VNRA - FT Days** **POSITION HIGHLIGHTS:** + **Quality of ... Leave, just to name a few. **Narrative: Contracting Specialist ** - The Eddy/St. Peter's Health Partners - Troy,...needed. + Coordinates with program directors to ensure regulatory compliance of contract terms. + Works with Executive Vice… more
- UTMB Health (Galveston, TX)
- …Obtains and documents information required for third party reimbursement. + Ensures compliance with Medicare and third-party coverage. + Communicates with ... Patient Services Specialist II- TDCJ Holdover **Galveston, Texas, United States**...services for new and returning patients. **ESSENTIAL JOB FUNCTIONS:** Lead Responsibilities: + Ability to function as a team… more
- University of Washington (Seattle, WA)
- …Lake Union. The CTS reports to the Senior Research Implementation Manager and Lead Clinical Trial Specialist . This position interacts closely with multiple ... Hematology and Oncology, has an outstanding opportunity for a Clinical Trials Specialist (CTS) to join their team.** **POSITION PURPOSE** The Division of Hematology… more
- SSM Health (St. Louis, MO)
- …Mission Hill **Worker Type:** Regular **Job Summary:** Coordinates regulatory compliance activities. Works collaboratively with leaders, clinicians and other staff ... meet regulatory requirements. Ensures implementation of an integrated regulatory compliance and accreditation program. **Job Responsibilities and Requirements:** PRIMARY… more
- Centene Corporation (Topeka, KS)
- …workplace flexibility. **Position Purpose:** The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical ... on national, regional and multi-plan initiatives. Develops programs in compliance with accreditation and regulatory requirements/ standards and monitors ongoing… more
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