- Public Consulting Group (Annapolis, MD)
- …and cultivate relationships with potential clients with a particular focus on state Medicaid agencies, children's behavioral health, child welfare and juvenile ... more, visit www.publicconsultinggroup.com . _Key responsibilities include:_ _Project Management_ + Lead the planning, execution, and monitoring of Medicaid … more
- Humana (Annapolis, MD)
- …risk, compliance , regulatory or related experience). + Regulatory or Medicare/ Medicaid compliance experience. + Auditing experience working with auditing ... first** Humana Healthy Horizons in Virginia is seeking a Compliance Professional 2 who will lead incoming...as Health and Human Services' Centers for Medicare and Medicaid Services (CMS) and EQROs. + Supports compliance… more
- Sumitomo Pharma (Annapolis, MD)
- …the Medicaid rebate team in receiving, processing, validating, trouble-shooting Medicaid claims and dispute resolution with state agencies. This position ... role with 2-3 days a week required in office. **Job Duties and Responsibilities** + Lead operations person for all Medicaid decisions as it relates to Model N… more
- Johns Hopkins University (Baltimore, MD)
- …manual or job aides for routine and special training programs. + Serves as Lead for compliance training and prepares and/or reviews all billing compliance ... manage and ensure the development and delivery of billing compliance education in accordance with the Office of ...in accordance with CPT coding standards and Federal and State regulatory guidelines. + Assumes responsibility for designing and… more
- CareFirst (Baltimore, MD)
- …throughout the organization and effectively collaborating with key stakeholders to promote compliance . Oversee Medicare and Medicaid Compliance functions and ... as the primary contact for Centers for Medicare and Medicaid Services (CMS) for Medicare compliance communications....and human resource procedures and regulations. + Experience in state and federal regulatory oversight (ie, CMS). + Experience… more
- Sevita (Baltimore, MD)
- …the United States. Our extraordinary team offers innovative, quality services and support that lead to growth and new opportunities for the people we serve and for ... our employees. **Summary** The Clinical Compliance Auditor is responsible for collaborating with Operations and Revenue Cycle in auditing/monitoring compliance … more
- Sevita (Baltimore, MD)
- …non-scheduled compliance audits according to the audit plan while testing compliance with appropriate federal, state , and local regulations and standards; ... the United States. Our extraordinary team offers innovative, quality services and support that lead to growth and new opportunities for the people we serve and for… more
- HealthEdge Software Inc (Annapolis, MD)
- …(from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid , and commercial), payment integrity, and healthcare plan ... payment/policy configuration, provider relations, medical management, medical economics, audit, compliance ) related to implementation/consulting engagements, strategic user adoption initiatives,… more
- Humana (Annapolis, MD)
- …service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include national clinical ... Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and/or Medicaid requirements, and will understand how to operationalize this knowledge in… more
- CareFirst (Baltimore, MD)
- …organization's pharmacy vision and strategic plan for government programs (Medicare and Medicaid ). This role has oversight of pharmacy staff and develops and ... the Maryland Department of Health (MDH) and US Centers for Medicare and Medicaid Services (CMS). **ESSENTIAL FUNCTIONS:** + Provides oversight and support for the… more
- Prime Therapeutics (Annapolis, MD)
- …management experience + 3+ years of experience managing PBM program activities for a state Medicaid program with large population equal or greater than Louisiana ... of the account including financials, operations, and overall performance. This role will lead a team to develop and execute account plans including retention and… more
- Humana (Annapolis, MD)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. **Use your skills to make an impact** **Required… more
- Humana (Annapolis, MD)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines. **This is a full-time work from home opportunity.… more
- Humana (Annapolis, MD)
- …meet authorization requirements. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... thinking and authorship. Exercises independence in meeting enterprise expectations and compliance timelines. Completes other duties as assigned. This is a full-time… more
- Humana (Annapolis, MD)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. **Some weekend work may be required.** **Required… more
- Community Clinic Inc. (Silver Spring, MD)
- …in community. As a Federally Qualified Health Center (FQHC), our mission is to lead the way to a more equitable healthcare system for everyone. Located in the ... and Montgomery Counties serving over 34,000 patients. + Oversees several federal, state , and county contracts and/or grants that focus on clinical operations,… more
- CAI (Annapolis, MD)
- …responses and create tailored solutions for complex RFP requests in the Medicaid , Medicare, Child Welfare, and/or Child Support areas. **Job Description** **Job ... create tailored solutions for complex RFP requests in the Medicaid , Medicare, Child Welfare, and/or Child Support areas. This...will be **full-time** and **remote.** **What You'll Do** + Lead the review process for RFPs to determine suitability… more
- Humana (Annapolis, MD)
- …necessity and appropriateness of services rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality standards. ... + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about...Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will… more
- HealthEdge Software Inc (Annapolis, MD)
- …**Your Impact** **: ** + Develop the product roadmap forclaimsvalue stream and lead high-level epic planning for current and futurequarters + Lead and ... and coordinate delivery of multiple product features across multiple engineeringteams + Lead engineering grooming sessions for selected epics and stories + Work… more
- Humana (Annapolis, MD)
- …to use your expertise in data analysis and problem solving to ensure compliance with state and federal regulations. Responsibilities include: + Subject matter ... audits and compliance mock audits + Ensure compliance with all Federal and state requirements....update and maintain various reports and policy/procedure documents. + Lead projects with internal/external areas related to required process… more