- Medical Mutual of Ohio (Brooklyn, OH)
- …controls and risks. . Working knowledge of SQL, QMF, and or other data extract methods. Medical Mutual is looking to grow our team ! We truly value and respect ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans....places in and around town, just for being a Medical Mutual team member. + The opportunity… more
- CVS Health (Boston, MA)
- …a Medicare Part B Operations Coordinator, you will support the Revenue Cycle Medicare Part B Team in reducing bad debt, eliminating legal risk and ensuring ... Performing root cause analysis and providing findings/suggestions to the Medicare Part B leadership team + Assistance...to detail, accuracy and follow through + Knowledge of medical billing and/or Medicare Part B Policy… more
- AdventHealth (Altamonte Springs, FL)
- …in a timely and efficient manner . Update, review, and maintain supporting documentation for the Medicare and Medicaid Uniform Contractual Worksheet-Third Party ... and State Medicaid programs, including changes affecting hospital reimbursement of Medicare bad debt, graduate medical education, disproportionate share hospital… more
- The Cigna Group (Morris Plains, NJ)
- … Client Strategy Senior Manager is accountable for and provides leadership to a team of Medicare Strategists and is responsible for contributing to and driving ... the team strategy to ensure continuous improvement and enhancement of...support in collaboration with account teams to support our Medicare clients. This client-facing position will take a lead… more
- USAA (Tampa, FL)
- …currently seeking a dedicated **Business Process Owner Senior** that will support Medicare Supplement Claims for USAA Life Company Claims Operations. This employee ... the Life Company Chief Claims & Fraud Officer and will work on Medicare Supplement Claims activities and ensure a flawless execution of business-related processes,… more
- Vanderbilt University Medical Center (Nashville, TN)
- **Discover Vanderbilt University Medical Center:** Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, ... information to all levels of leadership. Participates in the assembly of documentation and data to support analytical reporting to senior business operational… more
- Sedgwick (Naperville, IL)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Sr Medicare Associate **PRIMARY PURPOSE** **:** To gather documentation required to ... complete Medicare Compliance referrals and process Medicare mail electronically in a timely manner; **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews JURIS… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations. The Medicare ... various sources including federal and state regulations. + Applies clinical guidelines, Medicare regulations, and study team guidance of conventional care to… more
- Point32Health (Canton, MA)
- …Manager will participate in product strategy/bid planning meetings led by Product Strategy team to provide subject matter expertise, as needed, on matters related to ... be responsible for either directly populating the PBPs or will oversee the team 's Product Specialists who populate the PBPs with approved benefit details. The Senior… more
- The Cigna Group (Bloomfield, CT)
- The Medicare Technology Operations organization is looking for experienced, innovative and motivated leaders with strong technology engineering and cloud acumen, a ... empathic collaboration. The Cloud Engineering Senior Manager will oversee a team dedicated to creating and delivering high-quality cloud solutions for our… more
- The Cigna Group (Austin, TX)
- …analyses for Medicare Advantage business, including, but not limited to: medical expense analyses and projections, financial forecasts, Medicare Part C bid ... ad hoc actuarial analyses/advice as needed. **Responsibilities:** Primary focus areas are Medicare pricing and CMS bid and supporting documentation development,… more
- The Cigna Group (Philadelphia, PA)
- …analyses for Medicare Advantage business, including, but not limited to: medical expense analyses and projections, financial forecasts, Medicare Part C bid ... updates/results to management and associates. **Responsibilities:** Primary focus areas are Medicare pricing and CMS bid and supporting documentation … more
- Carle (Urbana, IL)
- …September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted. ... RN - Medicare Wellness Mahomet/Monticello + Department: ACO Clinical Improvement...standards of care and scope of practice. + Ensures documentation of care is complete and accurate. + Provides… more
- Carle (Urbana, IL)
- …September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted. ... RN - Medicare Wellness + Department: ACO Clinical Improvement +...standards of care and scope of practice. + Ensures documentation of care is complete and accurate. + Provides… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of… more
- CVS Health (Monroeville, PA)
- …the appropriate documentation to form all levels of appeals for Medicare + Third party follow-up associated with the dispensing g of prescription medication ... the tools and resources you need to be successful in a collaborative team environment. Located in the Monroeville facility, this opportunity also provides free… more
- PruittHealth (Norcross, GA)
- …responsibilities for all assigned locations. This position functions within a team environment and under general supervision. Successful individuals manage a volume ... skilled at problem solving and account resolution. They work well within a team and help foster an environment where continuous improvement in business processes and… more
- SUNY Upstate Medical University (Syracuse, NY)
- …clarification or optimization are identified, the CDI Specialist will collaborate with the medical team to clarify necessary items through a dedicated and ... Job Summary: The Clinical Documentation Improvement (CDI) Specialist primary responsibility is to...(CDI) Specialist primary responsibility is to ensure the inpatient medical record accurately supports severity of illness and risk… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …and compiles data that contribute to measuring and improving provider medical record documentation . Designs, prepares, and distributes meaningful reports ... using multiple databases. * Manage audit processes of medical record documentation and facilitates monitoring, tracking, and trending of audit results. Collect… more
- McLaren Health Care (Pontiac, MI)
- …is responsible for facilitating improvement of the overall quality and completeness of medical record documentation . CDI Specialist role is to facilitate quality ... Working DRGs & ICD10 CM/PCS codes. + Facilitates necessary documentation in the medical record through extensive...patients. + Educates all members of the patient care team regarding clinical documentation needs, changes to… more