- 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
- Carle (Urbana, IL)
- Medicare Compliance Analyst - HYBRID + Department: HA - Compliance & Risk Mgmt + Entity: Health Alliance + Job Category: Professional + Employment Type: Full ... No Email a Friend Save Save Apply Now Position Summary: The Medicare Compliance Analyst is responsible for understanding, researching, interpreting,… 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
- 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
- Molina Healthcare (Bowling Green, KY)
- …+ Collaborate with cross-functional teams to align call center operations with Medicare compliance and quality standards. **Operational Excellence** + Oversee ... leaders and staff are working on retention and expansion initiatives. + Ensure compliance with Medicare guidelines and regulations. + Drives and maintains… 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
- 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,...Bachelor's degree or equivalent. **5+ years of experience with Medicare Risk Adjustment-is required.** 5+ years of experience working… 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
- CareFirst (Owings Mills, MD)
- …**Experience:** 3 years' experience in project related field **Preferred Qualifications:** + Medicare Pharmacy experience + CMS Compliance experience + ... Medicare Prescription Payment Program standards and process knowledge + Project Management Professional Certification (PMP)Knowledge of Agile/Scrum methodology. **Knowledge, Skills and Abilities (KSAs)** + Proficient in Microsoft Office applications. +… 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
- 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 (Inglewood, 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 (National City, 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 (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 (Manchester, KY)
- …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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the creation of controls to manage fraud, waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse ... Pharmacy Benefit Manager on fraud waste and abuse work, present to the Medicare Compliance Committee and manage requests and audits from CMS. + Support the… more
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