- CVS Health (New Albany, OH)
- …and effectively operating in the market. As such, the Lead Director of Medicare Operations supports MAPD and SNP initiatives and implements and oversees ... of the Chief Medicare Officer, may facilitate internal and external Medicare audit activity including CMS and operations integrity audits. Coordinates file… more
- Medical Mutual of Ohio (OH)
- …help our members achieve their best possible health and quality of life. ** Medicare Sales Operations Specialist** Executes all end-to-end functions relating to ... and other fulfillment needs identified for the business area. **Sr. Medicare Sales Operations Specialist** Executes end-to-end functions relating to… more
- CareOregon (Portland, OR)
- …the development and deployment of reporting and analytics utilized to oversee Medicare 's operations and support strategic efforts. + Ensures internal systems, ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Sr Vice President, Medicare Department Medicare Administration Exemption Status Exempt Requisition #… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running ... required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter… more
- Molina Healthcare (NY)
- …+ 5-10 years' experience in Managed Care, specifically government programs and/or Medicare /Duals Health Plan Operations + Strong leadership in a matrixed ... regulatory requirements. **Job Duties** + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and compliant execution of… more
- CVS Health (Woonsocket, RI)
- …critical role in helping to establish a new department supporting member-facing financial operations activities for Medicare Part D members utilizing the ... or operational environment. You will work with colleagues across PBM Finance Operations , Treasury, Premium Billing, and have direct contact with account management… more
- Humana (Louisville, KY)
- …include: + Research, understand and apply laws, regulations, and regulatory guidance for DSNP Medicare Operations . Serve as the subject matter expert on DSNP ... Medicare Operations . + Develop audit methodology and perform auditing and monitoring activity to prevent and detect issues of noncompliance and provide guidance… more
- Healthfirst (NY)
- …+ Leads or participates in product-driven workgroups, to provide input to product designs/enhancements and implementation plans + Works with key stakeholders ... (including, but not limited to Regulatory, Claims Configuration, Provider Ops, Appeals & Grievance, Medical Management, Enrollment & Billing, Sales) to identify, scope and accurately implement new benefits, services, or other product changes, update processes… more
- CVS Health (Carson City, NV)
- …Experience with Medicare Advantage, SSI or Medicaid product sales or operations . - Microsoft experience, specifically Excel and PowerPoint - Health & Life ... Las Vegas Nevada area** Aetna is looking for a Medicare Sales Broker Manager to join the Nevada sales...sales results through an assigned Nevada hierarchy of independent Medicare brokers. Responsibilities include: - Develop and execute market… more
- LA Care Health Plan (Los Angeles, CA)
- …designing, enhancing, and implementing comprehensive compliance programs and managed care operations for Medicare , Medicaid, and commercial health plans. ... Advisor Regulatory Operations Job Category: Administrative, HR, Business Professionals Department: Compliance Location: Los Angeles, CA, US, 90017 Position Type:… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …field. * 1-3 years of experience in Medicare Part D and/or Medicare Advantage operations , documentation management, or a related field. * Proven hands-on ... in providing integrated solutions for government-sponsored health plans, including Medicare , Medicaid, and commercial plans. The company focuses on enhancing… more
- CVS Health (Houston, TX)
- …regularly with internal departments, including but not limited to: Finance, Medicare Operations , Network Management, Provider Contracting, and Health Economics, ... + Knowledge of government-regulated healthcare programs such as Medicaid or Medicare + Healthcare experience or knowledge of health insurance concepts +… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …role responsible for client relationship or account management. * Experience in a Medicare Advantage healthcare operations environment working with Medicare ... innovative solutions to drive effective change. A subject matter expert in Medicare processes, the manager ensures services align with client goals and regulatory… more
- Humana (Columbus, OH)
- …to assigned health plan and/or specialty companies relative to Medicare /Medicaid/TRICARE/Employer Group product implementation, operations , contract compliance, ... + Bachelor's degree or equivalent + 3 - 5 years experience with Medicaid/ Medicare /Employer Group operations + 3 - 5 years managing large scale projects and cross… more
- UCLA Health (Los Angeles, CA)
- …appeals, grievances, utilization management, or potential quality issues * Knowledge of Medicare Advantage plan operations and CMS regulations, highly desired * ... of medical care and services rendered in relation to Medicare guidelines, compliance requirements, and internal policies. + Identifying...of 2 years' experience in a managed care or Medicare Advantage setting is highly desired * Experience in… more
- CVS Health (New Albany, OH)
- …projects timely. + Works across business units as needed (Medicaid and Medicare service operations ). Develops and implements strategic business plan to ... shared services partners **Required Qualifications** + 5+ years working knowledge of Medicare and Medicaid programs + 5+ years operational background within a health… more
- Medical Mutual of Ohio (OH)
- …I** Working under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and ... under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part...complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part… more
- AdventHealth (Altamonte Springs, FL)
- …Medicare Data & Finance Analyst is responsible for serving analytics needs across operations and finance in support of risk-based Medicare ventures. This role ... **Senior Medicare Data & Finance Analyst** **Location:** Virtual **All...& Finance Analyst will engage with the finance team, operations team, health plan partners, providers, and vendors in… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- The Medicare Billing and Follow-up Representative are responsible for the compliant, accurate and timely billing and follow-up of all hospital Medicare and ... limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both electronic and...deemed necessary by management , to ensure efficient department operations + Report potential or identified problems with systems… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Facilitates and supports ... to work remote or hybrid; Ohio residents preferred._** **Responsibilities** ** Medicare Advantage Customer Experience Strategist** + **Facilitates projects to enhance… more
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