- 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Senior Medicare Compliance Analyst_ **Location:** _OH-Brooklyn_ **Requisition ID:** ... Implements and manages the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance -related activities for the… 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
- 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
- Centene Corporation (Austin, TX)
- … with federal and state legal and regulatory requirements as it relates to Medicare compliance and HPMS/CMS regulations. + Oversee and monitor various of ... language. + Oversee, administer, and implement various aspects of the Medicare Compliance program. + Provide guidance to various departments regarding … more
- Robert Half Finance & Accounting (Bridgewater, NJ)
- …about any discrepancies or issues with billing + Understand and adhere to all Medicare Compliance policies + Stay updated on current Medicare billing ... Description + Handle billing for Medicare patients, ensuring all claims are submitted correctly...billing trends + Assist with internal audits related to Medicare billing practices Requirements The ideal candidate will have… more
- Medical Mutual of Ohio (OH)
- …functions relating to the investigation of sales violations and complaints to the Medicare Advantage Sales Compliance area issued via Appeals and Grievances ... execute processes previously identified in order to meet and achieve compliance with regulatory requirements. **Responsibilities** ** Medicare Sales Operations… 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. ... experience (10 years' experience total). + Knowledge of billing compliance and Medicare regulations. + Excellent oral and written communication skills and… 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 laws, ... 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
- Hunterdon Health Care System (Flemington, NJ)
- …Promotes education for self and others by means of webinars and teleconferences offered by Medicare + General & Medicare Compliance : Medicare and Coding ... Responsible for application and maintenance of medical necessity software, insuring compliance relating to Medicare billing requirements, conducting internal… more
- Sharp HealthCare (San Diego, CA)
- …a variety of administrative support functions for the Director, the Manager Commercial Compliance , the Manager Medicare Compliance , the Lead Oversight & ... Under minimal supervision, exercises responsibility as administrative coordinator for the Compliance and Regulatory Affairs Department. Reporting to the Director … 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
- AdventHealth (Glendale Heights, 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
- AdventHealth (Altamonte Springs, FL)
- …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
- 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)
- …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
- Health First (Melbourne, FL)
- …secure the required forms to meet compliance with regulatory policies. 3. Perform Medicare compliance review on all applicable Medicare accounts in order ... sustainable levels of internal and external customer service, regulatory compliance , and financial performance within the revenue cycle. *Primary Accountabilities*… more
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