- CVS Health (Hartford, CT)
- …the review and report out on vendor performance across all of Medicare Appeals . This role requires business operational acumen to communicate effectively ... the OrganizationVendor/outsourcing knowledge **Preferred Qualifications** + Deep understating of Medicare Appeals /Healthcare Business + Understanding of Resource… more
- The Cigna Group (Nashville, TN)
- …to financial, affordability, growth and quality performance targets for Cigna Medicare . Negotiate and contract provider service and vendor agreements ... **What You'll Do** The Medicare National Contracting Advisor position is an integral...contributor for the development of a national provider and vendor value-based network and is accountable for the management… more
- Teleflex (Wayne, PA)
- …to customers and the sales force for insurance claim processing and appeals . **Principal Responsibilities** * Direct customer interface * Identify trends in customer ... internal and external customers * Support the claims and appeals process including the tracking of claims and ...management of timelines for key department initiatives * Manage vendor projects: Work within approved project and budget plans,… more
- State of Colorado (Denver, CO)
- …programs in Colorado's 64 counties and delivers technical support, monitoring, program improvement, regulatory oversight, and other quality assurance functions. The ... presentation, implementation, monitoring and execution support services to DCW program managers and administrators. While performing this duty, this position:… more
- Cardinal Health (Columbus, OH)
- …perform case management supporting patient access to therapy in accordance with the program business rules. This position is responsible for guiding the patient and ... as well as assist with any prior authorizations or appeals to facilitate coverage and dispense of product in...effective, empathetic and professional communication + Clear knowledge of Medicare (A, B, C, D) + 1-2 years of… more
- Essentia Health (Bismarck, ND)
- …of coverage, facilitating prior authorizations (PA), evaluating and supporting appeals requests, and conducting utilization management functions. The pharmacist will ... and prescribing patterns for designated drug therapies; supporting patient assistance program (PAP) team members with regard to clinical questions and patient… more
- LA Care Health Plan (Los Angeles, CA)
- …training materials delivered to various internal departments and off site Call Center vendor to measure product knowledge. As needed, this position will be assisting ... and Outreach, Ansafone, Web Inquiries, MRU (Member Relations Unit), and Appeals and Grievance, performance against key performance indicators and recognizes trends… more
- Insight Global (Los Angeles, CA)
- …Perform Retiree Drug Subsidy (RDS) reconciliation and compliance. Handle reconciliation of Medicare Drug Subsidy program and CMS Section 111. Coordinate with ... where applicable. Monitor Delta Dental, ESI and Anthem Discrepancy reports through vendor 834 files and resolve issues. Monitor and follow-up on Affidavit of… more
- Guidehouse (Lewisville, TX)
- …/ self-motivated. + Good communication and interpersonal skills. + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer ... staff as well as our in-house client specific training program . Representatives will perform any and all job-related duties...and imaging systems, internal host system - METRIX, internal vendor systems and call center platforms + Complete all… more