- KPH Healthcare Services, Inc. (East Syracuse, NY)
- **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides ... oversight and management of Medicare Part D /EGWP program. **Job...client benefit. Aid internal teams to support clients and business partners. **Responsibilities** + Provide oversight of operational activities… more
- Medical Mutual of Ohio (OH)
- …a fully remote opportunity_** . **_Eastern & Central Time Zones preferred. Extensive Medicare Part D experience is highly sought after._** ... to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and...Medicare Pharmacy Coordinator I** . Associate Degree in Business Administration, Healthcare, or related field or equivalent combination… more
- Dignity Health (Phoenix, AZ)
- …the regulatory compliance program for both Medicare Advantage ( Part C) and Medicare Part - D plan activities for Mercy Care Plan. Mercy Care Plan is ... Develops and monitors the implementation of and compliance with Medicare policies and procedures through the creation and implementation...can receive up to $18,000 over five years, while part -time employees can receive up to $9,000. While you're… more
- Magellan Health Services (San Diego, CA)
- …Rx Management clients for medical pharmacy/specialty, PBM, MRX Navigate, and Medicare Part D areas of business . Performs follow-up to ensure reviews ... occur as scheduled and written reports are generated by Physician Clinical Reviewers (PCRs). Analyzes pending completion rate based on PA review due dates. Provides updates to relevant departments to ensure turnaround time compliance with accreditation and… more
- Elevance Health (Columbus, OH)
- …geographic regions and lines of business , requires substantial knowledge in the Medicare business as well as an understanding of the intricate workings of ... pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account...-Understanding of the benefit design and formularies, specifically for Part D . -Experience in a pharmacy benefit… more
- CareFirst (Owings Mills, MD)
- …Coverage (EOC) / Annual Notice of Change (ANOC); Explanation of Benefits (EOB); Part D sponsor websites (CVS/Caremark Websites); Notification Prior to Point of ... order to travel into local offices.** **PURPOSE:** The Senior Business Analyst to support our ** Medicare Prescription...The Senior Business Analyst to support our ** Medicare Prescription Payment Plan (M3P)** functions will have the… more
- Centene Corporation (Raleigh, NC)
- …+ 5+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required. + Some ... anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of regulatory requirements… more
- Trinity Health (Farmington Hills, MI)
- …billing and follow-up activities within the revenue operations for an assigned Patient Business Services (PBS) location. Serves as a member of the billing and ... in behaviors, practices, and decisions Performs daily activities as part of the billing and follow-up team in support...High school diploma or Associate's degree in Accounting or Business Administration or related field, and a minimum of… more
- Elevance Health (Atlanta, GA)
- …regulations for program areas including but not limited to: claims, grievances and appeals, Part D and risk adjustment. + Knowledge of Risk Adjustment Payment ... vary depending on the above factors as well as market/ business considerations. No amount is considered to be wages...and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within… more
- US Tech Solutions (May, OK)
- …requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided through ... requires schedule flexibility and additional cross training to learn all lines of business . + Flexibility for movement to different parts of the business … more
- Mitsubishi Chemical Group (Jersey City, NJ)
- … business . + Develop, refine, implement, and pull through the MTPA contracting strategy for Medicare Part D , PBMs, GPOs and Commercial + Manage all Payer ... engagement with key customers and external groups including Commercial Payers, Medicare , Medicare Advantage plans, Part D , PBM's, GPOs, Commercial, FFS… more
- Central Maine Medical Center (Bridgton, ME)
- …priorities and performance and outcomes measures, as well as with departmental, business and organizational goals and objectives. In addition, and in concert with ... shifts. c) Effectively manages change at a departmental level d ) Identifies readiness for change and involves staff in...awareness of TJC (The Joint Commission), CMS (Centers for Medicare Services) and other required quality and safety measures… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …3. Support our Medicare Enrollment teams ( Medicare Advantage, Medex, and our Part D PDP teams) by cross training on other enrollment functions and assist ... by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of, we' d love… more
- Walgreens (Deerfield, IL)
- …able to address/understand/discuss complex reimbursement systems and flow of the healthcare dollar ( Medicare Part B/ D , ACOs, GPOs, Hospitals, etc.). **This ... work weekends and nights as needed.** **Job Responsibilities** + ** Business Planning** - Demonstrates an ability to build, adapt,...experience with billing procedures for hospital, medical offices and Medicare (B / D benefits). + Experience… more
- Trinity Health (Muskegon, MI)
- …opportunities specifically for patients enrolled in Marketplace policies, Medicare and Medicare part D . + Proactively enrolls all qualifying patients ... Clinical Financial Consultant will need:** **Minimum: Bachelor's degree in finance, business , counseling, social work, or job experience preferred.** + Preferred:… more
- US Tech Solutions (May, OK)
- …requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through ... requires schedule flexibility and additional cross training to learn all lines of business . Flexibility for movement to different parts of the business to… more
- US Tech Solutions (May, OK)
- …requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through ... requires schedule flexibility and additional cross training to learn all lines of business . Flexibility for movement to different parts of the business to… more
- AdventHealth (Rome, GA)
- …family, staff, and physician satisfaction. Understands the impact of dissatisfaction on the business goals of the unit. d . In coordination with the Director ... **Our promise to you:** Joining AdventHealth is about being part of something bigger. It's about belonging to a...of patient care services, including but not limited to Medicare , Managed care, Medicaid, third-party providers, challenges to current… more
- Marshfield Clinic (Eau Claire, WI)
- …Center:** 301081251 Systems Operations **Scheduled Weekly Hours:** 4 **Time Type:** Part time **Job Description:** **POSITION TITLE:** Assistant Service Line Medical ... service line physicians c. Annual review of Advanced Practice Clinicians d . Market share/specialty planning, including outreach e. Budget and financial performance… more
- UNC Health Care (Smithfield, NC)
- **Description** Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities ... to resolve credit balances through refunds or posting adjustments. Compiles Medicare /Medicaid Cash Reports and quarterly Credit Balance reports. 6. Payor Audits… more