- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …national physician specialty organizations, American Medical Association, Centers for Medicare and Medicaid Services (CMS/HCFA), Louisiana Medicare ... systems is required **Accountabilities & Essential Functions:** + Leads the configuration , implementation, maintenance and documentation of Payment management… more
- Commonwealth Care Alliance (Boston, MA)
- …public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics + ... HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims' processing policies, coding principals and payment methodologies… more
- LA Care Health Plan (Los Angeles, CA)
- …or in Payment Integrity. At least 5 years participating in healthcare ( Medicare , Medicaid , Commercial). At least 5 years of experience with health care ... Payment Integrity Analyst III Job Category: Claims Department:...implementation. Skills Required: Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare , and Medicaid rules and regulations. Working… more
- UPMC (Pittsburgh, PA)
- …savings, along with ensuring payment accuracy and payor (ie Medicare , Medicaid ) compliance. **Responsibilities:** + Provide in-depth analysis of professional ... UPMC Health Plan is hiring a full-time Payment Accuracy Analyst to support the Hospital Reimbursement...participates in cross-functional efforts including the Claims Operations, Systems Configuration , Medical Policy, & IT departments and acts as… more
- Commonwealth Care Alliance (Boston, MA)
- …as necessary on all new and revised coding logic, related Medicare / Medicaid policies for review/approval through the Payment Integrity governance process. ... public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics +… more
- Commonwealth Care Alliance (Boston, MA)
- …the department's project manager for: (1) regulatory information such as proposed and final Medicare and/or Medicaid payment regulations, Medicare Manual ... ensure successful completion of change + Serve as the company's research specialist regarding Medicare and Medicaid payment policies + Serves on the… more
- Intermountain Health (Murray, UT)
- …contracts related to payment integrity and monitoring, reviewing and interpreting Medicare and Medicaid policies, payment methodologies, and updates to ... data related to the payment of contracts, fee schedules and Medicare and Medicaid regulations and methodologies. Conducts internal and external contract… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... all regulatory products. Responsible to reconcile the accuracy of payment file received from online premium payment ...P&P's + Serve as resource to other areas for Medicare and Medicaid questions/issues + Assists Management… more
- Molina Healthcare (Albuquerque, NM)
- …* This position plans, organizes, staffs, and coordinates the operations of state Medicaid /CHIP, Medicare and Marketplace Health Plan operations. * Works with ... the functionality of Health Plan Operations. * Directly manages the Plan's benefit configuration , claim payment policies and the maintenance or modification of… more
- System One (Dayton, OH)
- …and within a team environment + Attention to detail + Knowledge of Medicare , Medicaid or Marketplace medical insurance benefits preferred + Claims processing ... complex medical business requirements into configurable requirements and working with configuration and other partners in helping to develop the strategic direction… more
- Commonwealth Care Alliance (Boston, MA)
- …of business processes, software systems, and technology platforms that support Medicare and Medicaid Health Plans. **Supervision Exercised:** No, this ... experience that has served in multiple roles such as product owner, configuration lead, product management, and/or business consultant. + Experience in coaching… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... and hands-on within Splunk AWS; editing and maintaining Splunk configuration files and apps. As a Senior software engineer,...Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home… more
- HealthEdge Software Inc (Columbus, OH)
- …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... Source_ ,we'rechanging the industry narrative, providing a moreholistic approachto payment integrity that focuses on comprehensive reimbursement, agile editing,...the reimbursement, payment integrity,… more
- HealthEdge Software Inc (Columbus, OH)
- …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... Source_ ,we'rechanging the industry narrative, providing a moreholistic approachto payment integrity that focuses on comprehensive reimbursement, agile editing,...the reimbursement, payment integrity,… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... database access and effectively allocate/reallocate database resources for optimal configuration , performance, and cost. + Support multiple services and multiple… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... first** The Data Manager 2 supports all aspects of configuration control, data management, and deficiency reporting. The Data...Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... + Establish and enforce best practices for using Dynatrace and ensure optimal configuration and utilization across the organization **Use your skills to make an… more