- CareFirst (Baltimore, MD)
- …and Legal departments to resolve complex issues with inter-related legal and Medicaid compliance aspects. **ESSENTIAL FUNCTIONS:** + Direct accountability for ... Office and Legal. Participates in and develops training and education regarding Medicaid Compliance throughout the business unit including the development of… more
- Humana (Juneau, AK)
- …process optimization and state submissions + Process Enhancement: Collaborate with the Senior Professional and Leads and recommend and implement business ... a part of our caring community and help us put health first** The Medicaid Process Improvement Professional 2 is responsible for analyzing and evaluating the… more
- Geisinger (Danville, PA)
- …are seeking a detail-oriented professional with expertise in Medicare and Pennsylvania Medicaid cost reporting to join our team. The ideal candidate will have a ... strong understanding of Medicare settlement processes, compliance requirements, and hospital reimbursement regulations. This role requires the ability to analyze… more
- Humana (Albany, NY)
- …claims operations, and other business teams involved in the administration of Medicaid business at Humana. The Senior Business Intelligence Engineer will ... development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root… more
- Humana (Louisville, KY)
- …may be a data scientist, financial analyst, economist, or other analytical professional ; though experience in Medicaid or government healthcare programs is ... performance, Value-Based Payment (VBP) strategy, audits, and NCQA accreditation. + Ensure compliance with Medicaid requirements and regulatory standards. + Drive… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... Health's core system. Completes work accurately and timely to remain in compliance with DOI, CMS and EOHHS regulations. Appropriately escalates concerns when… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Senior Quality Compliance Professional is an integral part of the Michigan Quality ... projects. The role operates as a subject matter expert in Quality Compliance . POSITION RESPONSIBILITIES: + Involved in studies as required by the External… more
- Point32Health (Canton, MA)
- …for Medicare and Medicaid Services (CMS) and, as applicable, State Agencies.The Senior Manager, Compliance Program will report to the Government Programs ... equivalent combination of education and experience. 5+ years of Medicare and/or Medicaid Compliance experience. Strong experience with Medicare and/or … more
- Mount Sinai Health System (New York, NY)
- …and Ancillary Contracts across the Mount Sinai Health System. MSHP seeks a Senior Contract Compliance ( Professional Billing) Analyst who will primarily ... to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's...be responsible for tracking, trending, and analyzing professional billing (PB) contract compliance issues. This… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …states (ME, NH, VT, MA, RI, CT)** Reporting to the Director of Billing Compliance , the Senior Billing Compliance Reviewer ensures the integrity, accuracy, ... regulatory compliance of Dana-Farber Cancer Institute's hospital and professional billing through data-driven audits and targeted monitoring. This role conducts… more
- Prime Therapeutics (Columbia, SC)
- …career? Come build the future of pharmacy with us. **Job Posting Title** Senior Compliance Analyst (Regulatory Change Management) - Remote **Job Description** ... The Senior Compliance Analyst assists in the implementation...and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management… more
- Prime Therapeutics (Little Rock, AR)
- …a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Senior Compliance Analyst - Remote **Job Description** The Senior ... Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management Professional (PMP)… more
- Humana (Columbia, SC)
- …and help us put health first** Humana Healthy Horizons is seeking a Senior Learning Design Professional who will use instructional design, cognitive psychology ... to determine the appropriate solution to a knowledge or performance gap. The Senior Learning Design Professional work assignments involve moderately complex to… more
- Baylor Scott & White Health (Nashville, TN)
- …**ESSENTIAL FUNCTIONS OF THE ROLE** This position will be supporting Hospital and Professional areas of billing compliance : . Conducts audits and assessments to ... ensure compliance with BSWH policies and CMS and Texas Medicaid regulations, providing reports, recommendations, and corrective action follow-up. Monitors trends… more
- Humana (South Bend, IN)
- …a part of our caring community and help us put health first** The Senior Community Management Professional will be responsible for directing community engagement ... of how to remove barriers to care in the Medicaid population. + Exercises professional judgment and...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Sacramento, CA)
- …part of our caring community and help us put health first** The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, ... and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex… more
- Humana (South Bend, IN)
- …Dual Eligibility Special Needs Plan (HIDE SNP) in Michigan is seeking a Senior Consumer Experience Professional who will ensure optimized interaction between ... Humana and our members. The Senior Consumer Experience Professional will work assignments...Care and/or Service Coordination team feedback, market or regulatory compliance information, Grievance and Appeal information, call listening, member… more
- Humana (Raleigh, NC)
- …a part of our caring community and help us put health first** The Senior Technology Solutions Professional devises an effective strategy for executing and ... delivering on IT business initiatives. The Senior Technology Solutions Professional work assignments involve moderately complex to complex issues where the… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Senior Health Equity Strategy Professional support the development of the organization's ... of health care equity to reduce or eliminate health disparities. The Senior Health Equity Strategy Professional work assignments involve moderately complex… more
- Humana (Salem, OR)
- …part of our caring community and help us put health first** The Senior Clinical Medical/Financial Risk Evaluation Professional is responsible for supporting the ... implementation and monitoring of medical/financial risk and healthcare fraud. The Senior Clinical Medical/Financial Risk Evaluation Professional work assignments… more
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