- Dignity Health (Phoenix, AZ)
- …and compliance committee, on the status of Mercy Care Plan's Medicare compliance program implementation, the identification and resolution of potential or ... corrective or disciplinary actions, if necessary. To that end, the Medicare Compliance Officer should have the flexibility to design and coordinate internal… more
- Centene Corporation (Austin, TX)
- …member of Medicare & Compliance Senior Leadership, chairs Centene's Medicare Compliance Committee, attends meetings of the Enterprise Compliance ... organization with a commitment to service leadership. + Leading the Medicare Compliance team with a collaborative mindset and demonstrated commitment to… 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 the ongoing oversight, analysis, review, and approval of all… 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 ... CVS Code of Conduct * Maintains current working knowledge and expertise in Medicare Compliance , Medicaid Compliance and State regulations in support of MMP… more
- Sedgwick (Naperville, IL)
- … Associate **PRIMARY PURPOSE** **:** To gather documentation required to complete Medicare Compliance referrals and process Medicare mail electronically ... a timely manner; **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews JURIS and the Medicare Compliance system to determines appropriate course of action and… 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
- 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
- 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 laws, ... position is full remote with occasional time onsite.** The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical...updates to the coverage analysis to ensure on-going regulatory compliance + Serves as the primary point of contact… more
- Point32Health (Canton, MA)
- …with healthcare program requirements. + **Collaboration:** At the direction of the Medicare Compliance Officer, collaborate with leadership and department heads ... and state laws and regulations related to the Government Programs Compliance Programs for Medicare and Duals products. This role involves guiding teams and… more
- CVS Health (Irving, TX)
- …Manager, FDR Oversight Program is an individual contributor career level position within Medicare Compliance who will execute operational and compliance ... to support our FDR Oversight program. In this role, they will support Medicare Compliance initiatives designed to ensure the seven (7) elements of an effective … more
- Axis (New York, NY)
- …of AXIS North America Claims with an immediate focus on Adjuster Licensing and Medicare Compliance . The successful candidate is a results-driven team player with ... compliant management of adjuster licenses. * Assisting with maintenance of Medicare policies and procedures, monitoring, summarizing, tracking compliance … more
- Medical Mutual of Ohio (OH)
- …under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare ... general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C… more
- Prime Healthcare (Redding, CA)
- …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both… more
- Prime Healthcare (Ontario, CA)
- …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both… more
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com . The Director of Compliance serves as the primary contact for Medicare and Medicaid ... compliance for **PerformRx** . The incumbent ensures overall compliance with all Medicare and Medicaid compliance activities and programs; contributes to… more
- AdventHealth (Bolingbrook, IL)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- LA Care Health Plan (Los Angeles, CA)
- …training programs and making presentations. Preferred: 2 years of Medi-Cal, Medicare or commercial product compliance . Regulatory change management and ... Compliance Advisor II Job Category: Administrative, HR, Business...California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and Knox-Keene requirements, as… more
- CareFirst (Baltimore, MD)
- … compliance programs, or related fields. **Preferred Qualifications:** + Healthcare Compliance certification(s). + Experience in CMS programs ( Medicare or ... programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Medicare and Medicaid Compliance **Equal Employment Opportunity**… more
- CareOregon (Portland, OR)
- … (CHC) Knowledge, Skills and Abilities Required Knowledge + Growing knowledge of Medicare and Medicaid compliance practices and procedures + Understanding of or ... Job Title Compliance Specialist Requisition # 24592 Exemption Status Exempt...of Federal Regulations, Oregon Revised Statutes and Administrative Rules, Medicare Advantage Manuals, etc.) + Effective computer skills (eg,… more
- CareOregon (Portland, OR)
- …insurance Knowledge, Skills and Abilities Required Knowledge + Advanced knowledge of Medicare and Medicaid compliance practices and procedures + Understanding of ... 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 Manager… more
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