• Sr Manager , Medicaid

    CVS Health (Scottsdale, AZ)
    …This position follows a hybrid working model of three days onsite per week The Sr . Manager , Medicaid Compliance Monitoring will lead a team of compliance ... to develop and execute a comprehensive audit and/or monitoring plan within our Medicaid line of business that enhances enterprise value and is executed in accordance… more
    CVS Health (11/07/24)
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  • Audit & Reimbursement Sr

    Elevance Health (Columbus, OH)
    **Audit & Reimbursement Senior ** **Location:** This is a virtual position; US based. _National Government Services is a proud member of Elevance Health's family of ... contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs._ The **Audit and Reimbursement … more
    Elevance Health (10/29/24)
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  • Sr . Associate, Internal Audit

    Commonwealth Care Alliance (Boston, MA)
    …follow-up validations of internal processes and vendors, as assigned. Apply auditing expertise to report on compliance with established internal control procedures ... key performance indicators Additional Responsibilities * Support Corrective Action Plan (CAP) Manager in communicating on new and existing CAPs emerging from source… more
    Commonwealth Care Alliance (11/26/24)
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  • Sr . Data Analyst, Risk Adjustment

    Point32Health (Canton, MA)
    …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the oversight of the Senior Manager of Consulting and Operations, this individual will support ... a health plan, provider group, healthcare IT / management consultancy or auditing firm. + Understanding of claims systems, provider information, Medicaid more
    Point32Health (11/16/24)
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  • Corporate Compliance (Medicare Duals)…

    CVS Health (Southfield, MI)
    …working schedule of three days onsite per week in Southfield, MI The Sr . Compliance Manager is an experienced/career level compliance position that applies ... and DSNP products in a highly matrixed environment. The Sr . Manager Compliance maintains productive relationships and...described in CMS Medicare Managed Care Manuals and applicable Medicaid rules including risk assessment, auditing and… more
    CVS Health (10/16/24)
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  • Individual & Family Plans (IFP) Claims Strategy…

    The Cigna Group (Bloomfield, CT)
    The Claims Strategy and Payment Integrity Senior Manager will play an important role in our Affordability strategy by providing claim payment oversight for the ... IFP claim administration activities against current industry policies/standards (especially IFP/Medicare/ Medicaid ). Additionally, this individual will lead a small team… more
    The Cigna Group (11/20/24)
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  • Senior Project Manager , Claims…

    CenterLight Health System (NY)
    JOB PURPOSE: The Senior Project Manager , Claims Payment Integrity supports the Senior Vice President and the Director in the day-to-day operations of the ... claim processing, including monitoring of pending claims, appeals, recoupments, pricing, auditing , and reporting. + Provide project management support in data… more
    CenterLight Health System (11/21/24)
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  • Fraud Waste and Abuse (FWA) Audit Manager

    Fallon Health (Worcester, MA)
    …and LinkedIn. **Brief summary of purpose:** Under the general direction of the Senior Internal Audit Manager , theAnalyze and interpret patient medical records ... be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in… more
    Fallon Health (11/09/24)
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  • Manager , Encounter Data Management

    Humana (Columbus, OH)
    …Finance, Operations or other related fields or 3+ years with Medicare and/or Medicaid claims processing or auditing experience + 2+ years of leadership, ... part of our caring community and help us put health first** The Manager , Encounter Data Management develops business processes to ensure successful submission and… more
    Humana (11/16/24)
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  • Patient Access Services Associate Manager

    Banner Health (Tucson, AZ)
    …team work goals. CORE FUNCTIONS 1. Under direction of PAS Director and/or Sr . Manager , provides mentoring and clear developmental opportunities to staff. Able ... by US News & World Report. The academic medical center has earned Magnet Recognition becoming the only hospital in southern Arizona to meet the rigorous standards of… more
    Banner Health (09/29/24)
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  • Coding Analysis Technology Specialist

    HCA Healthcare (Nashville, TN)
    …focus is on tuning the NLP through the investigation of focus areas as defined by CATT Sr . Manager and or Lead. + Analyze NLP Precision & Recall Outcomes on all ... patient types as assigned. Analysis by patient type/code set may be established by Sr . Manager /Lead but rotation of assigned types will occur. + Identify… more
    HCA Healthcare (11/21/24)
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  • Healthcare Compliance Manager

    Ramsey County (St. Paul, MN)
    Healthcare Compliance Manager Print (https://www.governmentjobs.com/careers/ramsey/jobs/newprint/4730411) Apply  Healthcare Compliance Manager Salary $83,490.36 ... Time Remote Employment Flexible/Hybrid Job Number 2024-01219 Department 21A01-County Manager /Admin Opening Date 11/15/2024 Closing Date 12/6/2024 11:59 PM Central… more
    Ramsey County (11/22/24)
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  • Compliance Program Manager III

    Point32Health (MA)
    …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the direction of the Director or Senior Manager of the department, the Compliance Program Manager ... as sharp analytical skills. By using knowledge of the company, the Compliance Program Manager III should be able to resolve most roadblocks to ensure success and… more
    Point32Health (11/20/24)
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  • Commercial Controller (FP&A/Gov Pricing/GTN)

    Kedrion Biopharma (Fort Lee, NJ)
    …working alongside KBI FP&A Manager , Melville Plant Controller, Senior Accounting Manager , Senior Manager Treasury & KBI Sales Director in a matrix ... team structure. Responsibilities: + Manage overall sales flow to meet revenue recognition rules and principles. + Develop and lead monthly review process with… more
    Kedrion Biopharma (10/07/24)
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  • Compliance Analyst I - Remote Hybrid Opportunity

    University of Rochester (Rochester, NY)
    Responsibilities **Position Summary:** **This position oversees outpatient Medicare, Medicaid and third-party payor audits, and directs all responses to assure ... for all internal and external sources regarding routine audits, including Medicare and Medicaid credit balance quarterly audits, audits obtained from the Office of … more
    University of Rochester (09/25/24)
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  • Mgr, Business Compliance

    CVS Health (Hartford, CT)
    …skills and development needs. + Assess training needs and collaborate with the SIU Sr . Manager to create development plans for team members. + Develop and ... with contractual requirements. + Coordinate and collaborate with compliance and senior leadership to align on program integrity initiatives. + Contribute to… more
    CVS Health (11/22/24)
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  • Director of Pharmacy

    State of Indiana (Indianapolis, IN)
    …of a role. About the Family & Social Services Administration: The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services ... Director of Pharmacy administers the state's pharmacy benefits for 1.9 million Medicaid members. You will coordinate population health strategies and integrate novel… more
    State of Indiana (11/14/24)
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  • Associate Director, Risk Adjustment Audit

    CenterWell (Tallahassee, FL)
    …CPT, & HCPCS codes that are submitted to the Centers for Medicare and Medicaid Services (CMS), other payers, and over government agencies. In addition, the Associate ... their linkages to related areas. **Productivity and Quality Management:** + Monitor auditing staff workload and redistribute resources as needed to meet market… more
    CenterWell (10/30/24)
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  • Director of Provider Oversight / Administrative…

    City of New York (New York, NY)
    …of regulation, law and policy. Experience with compliance measures and auditing , preferably including Medicaid . Understanding of program evaluation, performance ... WHO ARE PERMANENT IN THE CIVIL SERVICE TITLE OF HEALTH SERVICES MANAGER AND OTHER COMPARABLE CIVIL SERVICE TITLES INCLUDING, ADMINISTRATIVE STAFF ANALYST (ONLY… more
    City of New York (10/11/24)
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  • Financial Analyst

    NorthWest Senior & Disability Services (Salem, OR)
    …analytical accounting activities in support of the Agency's Finance and Budget Manager . Serves as a technical resource to fiscal services staff. Essential Functions ... + Support Finance and Budget Manager to meet goals and objectives. + Perform advanced...(GAAP) + Perform a wide range of advanced accounting, auditing , and budgeting assignments including preparation of journal entries,… more
    NorthWest Senior & Disability Services (11/22/24)
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