- Public Consulting Group (Raleigh, NC)
- …(CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight ... changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid… more
- HealthEdge Software Inc (Raleigh, NC)
- **Overview** **Overview:** The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting ... products (from basic to advanced features/functionality), payment methodologies/policies (Medicare, Medicaid , and commercial), payment integrity, and healthcare plan operations… more
- Novant Health (NC)
- Job Summary The Compliance Consultant is responsible for working with Compliance leaders to: + Ensure Novant Health and its affiliates compliance with state and ... federal regulatory requirements (including, but not limited to Medicare, Medicaid , and Tricare); + Interpret regulations and identify compliance requirements; +… more
- Elevance Health (NC)
- …the state of North Carolina and hold a Child & Adolescent Board Certification .** We are partnering with North Carolina DHHS to operationalize the single, statewide ... Medicaid Plan designed to support Medicaid -enrolled infants,...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- Elevance Health (NC)
- …are partnering with North Carolina DHHS to operationalize the single, statewide Medicaid Plan designed to support Medicaid -enrolled infants, children, youth, ... guidance for programs. + Serves as a resource and consultant to other areas of the company. + Prepare...and clinical guidelines within scope of license. + Conducts pre- certification , concurrent review, and appeals of Behavioral Health OP… more
- PruittHealth (Fayetteville, NC)
- …needs and services including providing written explanation of Medicare, Medicaid and Insurance benefits to prospective patients/families when necessary, and ... Participates in ongoing inservice education. * Acts as a consultant to agency personnel. * Coordinates care provided to...in your field as well as to maintain current license/ certification , as required. * Attend and participate in mandatory… more
- Elevance Health (Winston Salem, NC)
- …metrics to track performance and goal achievement. + Serves as internal consultant relative to continuous improvement initiatives. + Identifies and develops plans to ... and process improvement structure strongly preferred. + Six Sigma Black Belt certification preferred. + Certified Professional Coder (CPC) and or professional coding… more