- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …business partners. **Responsibilities** + Provide oversight of operational activities of Medicare Part D /EGWP programs + Ensure compliance with CMS rules ... **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides… more
- US Tech Solutions (May, OK)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- US Tech Solutions (AZ)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- Ankura (Chicago, IL)
- …and statistical methods; prescription drug claims submission and payment; pharmacy benefit administration; Medicare Part D compliance ; and the ... delivery services across the Firm. Practice Summary: The Healthcare Disputes, Compliance and Forensics practice focuses on assisting healthcare and life science… more
- Humana (Columbus, OH)
- …data analytics skills and attention to detail **Preferred Qualifications** + Basic understanding of Medicare Part D + Prior experience with Microsoft Excel ... **Become a part of our caring community and help us...for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations.… more
- Carle (Urbana, IL)
- …Two (2) years experience in compliance or health insurance with previous Medicare Advantage, or Part D experience. SKILLS AND KNOWLEDGE Knowledge ... Medicare Compliance Analyst - HYBRID +... Medicare Compliance Analyst - HYBRID + Department: HA -...a Friend Save Save Apply Now Position Summary: The Medicare Compliance Analyst is responsible for understanding,… more
- Medical Mutual of Ohio (OH)
- …supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part ... administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical… more
- Banner Health (AR)
- …8:00 AM - 5:00 PM (AZ Time). In this position you will be monitoring Medicare Advantage Parts C & D operational control measures ensuring appropriate oversight ... is in place for accurate, complete, and compliant for Medicare Advantage Parts C & D . +...a timely fashion. + Working in start-up environment + Medicare Advantage Compliance training, audits, regulations, and… 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 ... home anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of regulatory… more
- CVS Health (Hartford, CT)
- …working in a fast-paced environment with constant change Preferred Qualifications + Prior Pharmacy, Medicare Part D , Medicare or Medicaid experience + ... actuarial team supporting CVS Health and Aetna's Government Services Medicare Advantage and Prescription Drug Plan business. The position...position will provide modelling and analytical support for the Part D Business, with a focus on… more
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for...the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards… more
- Central Maine Medical Center (Lewiston, ME)
- …staff and other department managers.c) Creates and sustains a culture of safety. d ) Leads and manages change effectively.e) Responds to change productively, promotes ... meeting the goals, communicate the plan to staff and evaluate the outcome. d ) Maximizes care efficiency and throughput.e) Responsible and accountable for fiscal… more
- US Tech Solutions (May, OK)
- …exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided ... and Appeals Learning Advocates and management team as needed. + Must maintain compliance at all times with CMS and department standards. + Position requires schedule… more
- Humana (Columbus, OH)
- …to exercise independent judgment and thinking on complex issues **Preferred Qualifications** + Medicare Advantage and/or Part D experience + Demonstrated ... **Become a part of our caring community and help us...role is a role within the Senior Products Actuarial Compliance team focused on special Medicare Advantage… more
- Prime Therapeutics (Columbus, OH)
- …manage multiple projects within strict timelines, under pressure. + Working knowledge of Medicare Part D , Medicaid, state healthcare product or program ... and drives every decision we make. **Job Posting Title** Compliance Principal - Remote **Job Description** The Compliance...or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Boehringer Ingelheim (Ridgefield, CT)
- …developing a comprehensive discount accrual forecasts and by providing support for Managed Care / Medicare Part D group efforts as required in order to ... Department, this individual will provide support to the Associate Director, Contract Compliance and the Director of Contract Development, as applicable, and as it… more
- Humana (Columbus, OH)
- …questions. + Lead actuary owns responses related to Part B pharmacy projection and Part D bid base period development. + Coordinates with data suppliers and ... substantial. Part B Pharmacy Pricing **Lead Actuary** Part B Pharmacy Pricing + Own the Medicare...compliance to develop detailed responses to audit requests. The… more
- Humana (Columbus, OH)
- …state relationship management, optimizing Medicaid performance and ensuring alignment with Medicare and other Enterprise leaders. **Unified D -SNP Market ... **Become a part of our caring community and help us...and 5BN in revenue + Streamline complex interactions with Medicare and Enterprise leadership by providing a single point… more
- G-TECH Services, Inc. (Detroit, MI)
- …dashboard. * Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans. * Receive and respond to plan ... * Works with internal and external partners to ensure compliance with CMS regulations. * Performs routine tracking, auditing,...Required Skills * Working knowledge of Medicare Part B and Part D … 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 ... that all documents are distributed timely to remain in compliance with the Centers for Medicare and...Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of,… more