- Centene Corporation (Raleigh, NC)
- …from home anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of ... regulatory requirements associated with the Medicare materials and sales compliance . Participates in...review of difficult or detailed member and prospective member communications against regulations to ensure compliance . +… more
- CVS Health (Southfield, MI)
- … risks. The individual will work independently, as well as collaboratively, with internal senior level Medicare compliance and business teams that operate ... the CVS Code of Conduct * Maintains current working knowledge and expertise in Medicare Compliance , Medicaid Compliance and State regulations in support of… more
- Somatus (Mclean, VA)
- …well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of ... to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with governing bodies' regulations, including the Center for Medicare… more
- University of Michigan (Ann Arbor, MI)
- Senior Corporate Compliance Director - HIPAA Officer Apply Now **Job Summary** The Senior Corporate Compliance Director (? Senior Director?) is ... and oversight of Michigan Medicine?s (?MM?) statewide Corporate HIPAA Compliance Program (?Program?). The Senior Director?s responsibilities include,… more
- Penn Medicine (Bala Cynwyd, PA)
- …Our employees shape our future each day. Are you living your life's work? ** Senior Hospital Compliance Analyst** Job Summary: + Responsible for the performance ... documentation reviews at all hospitals owned by Penn Medicine to assure compliance with applicable federal and state regulations. Incumbent will also participate in… more
- ChenMed (Miami, FL)
- …practice matters, business insurance, risk management, and healthcare regulatory compliance . Senior Corporate Counsel will provide strategic legal ... we need great people to join our team. The Senior Corporate Counsel will provide senior level...ADEA, DOL, FLSA a big plus + Experience with Medicare required + Information Security (INFOSEC), Compliance ,… more
- The Cigna Group (Bloomfield, CT)
- …and the ability to influence and drive change. This position will ensure compliance with the Center for Medicare and Medicaid Services (CMS) guidance/regulations ... **Job Summary:** + Lead a team of Senior Advisors and Advisors responsible for the development...Advisors responsible for the development and management of the Medicare Prescription Payment Plan (M3P) product. This individual will… more
- Humana (Columbus, OH)
- …degree or other graduate degree + Healthcare, Provider research Experience + Medicare / Senior Consumer Experience + Experience with CMS STARs requirements, ... us put health first** Humana's Corporate Marketing Organization is looking for a Senior Market Research Professional to join the Market Research team working remote… more
- Aspen Dental (Springfield, IL)
- …current needs, we have an exciting opportunity to join our Payor Strategy team as Senior Manager, Payor Strategy. The Senior Manager of Payor Strategy plays a ... Strategy. **Essential Responsibilities** Responsible for working with Vice President + Senior Vice President of Payor Strategy on managing the contract portfolio… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... internal audits and assessments of its operational, financial and compliance controls. IA reports administratively to the Chief ...role in auditing risks identified in the organization. The Senior Internal Auditor plays a key role in implementing… more
- Healthfirst (NY)
- …an accredited medical school or similar clinical program + Knowledge of compliance and regulatory guidance/regulations across the Medicaid, Medicare , MLTCPs, and ... Prepares and presents reports on policy performance, trends, and outcomes to senior management and other stakeholders + Collaborates on policy reviews with committee… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Depending on level ... and highly complex enterprise-wide projects, programs, and teams with support, in compliance with the Company's defined project management standards with the goal of… more
- CVS Health (Raleigh, NC)
- …on our **Dual Eligible Special Needs Plan** (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social ... psychosocial, and mental health needs + Accountable to the highest level of compliance integrity + Champions for the member by connecting members with urgent needs… more
- MetLife (New York, NY)
- …how the company may meet its business needs while complying with applicable Medicare Advantage, Medicaid Managed Care, and state health insurance laws. The attorney ... on the legal requirements under government health care programs such as the Medicare Advantage and Medicaid Managed Care programs. * Research and analyze managed… more
- Humana (Columbus, OH)
- …Enterprise Observability engineering team is looking for a well versed and experienced Senior Software Engineer-Splunk. As a Senior Engineer, you should be ... Splunk AWS; editing and maintaining Splunk configuration files and apps. As a Senior software engineer, you will provide support for the full system engineering… more
- Nuvance Health (Danbury, CT)
- …role manages the credentialing process for existing and new providers and ensures compliance with all relevant standards including but not limited to Medicare , ... for network participation. Responsible for fostering effective relationships and communications with operational leadership, physicians, revenue cycle, payers, and… more
- Beth Israel Lahey Health (Boston, MA)
- …with any changes in ICD-10 and CPT-4 coding and remains current with Medicare , federal insurance and third party billing compliance regulations. Works ... descriptor codes including the appropriate use of modifiers to ensure compliance for reimbursement. Please note this role has remote work eligibility… more
- MarketSource (Alpharetta, GA)
- …efforts. Essential Job Functions: * Design, implement, and lead the insurance compliance management strategy for the organization's Medicare Advantage sales ... in embedding a culture of insurance compliance awareness * Ensure compliance with regulatory obligations including Centers for Medicare and Medicaid Services… more
- Vanderbilt University Medical Center (Nashville, TN)
- …by the American Health Information Management Association (AHIMA) and in compliance with ICD-10 Official Coding Guidelines and other regulatory requirements. Uses ... Diagnosis Related Groups (DRG) methodologies, including Medicare Severity DRGs (MS-DRGs) and All Patient Refined DRGs (APR-DRGs). Responsible for coding mortality… more
- CVS Health (Austin, TX)
- …psychosocial, and mental health needs - Accountable to the highest level of compliance integrity - Champions for the member by connecting members with urgent needs ... actions with a high level of detail to ensure we meet our compliance requirements - Protects the confidentiality of member information and adheres to company… more