- Humana Inc (Boston, MA)
- Become a part of our caring community and help us put health first The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... with requirements development. Creating and executing comprehensive test plans Ongoing Medicare Pricer maintenance, quality assurance, and compliance Determine… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …is fully remote with the ocassional time onsite as needed. The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, ... to patient insurance and which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies are a… more
- Humana Inc (Honolulu, HI)
- A healthcare company is seeking a Sr. Medicare Provider Hospital Reimbursement Analyst to manage Medicare reimbursement methodologies. This remote position ... will support reimbursement processes and analyze CMS regulations, ensuring compliance and optimal operational efficiency. A competitive salary between $89,000… more
- The Computer Merchant, LTD. (West Mclean, VA)
- …and gives both negative and positive feedback. Guides and mentors junior Systems Analyst staff in ensuring compliance with operations release standards and best ... JOB TITLE: Sr. Systems Analyst JOB LOCATION: Remote WAGE RANGE*: $58 -...actions to team leads and management Domain knowledge of Medicare , Medicaid, or healthcare verticals preferred Preferred Qualifications: Understanding… more
- University of Chicago Medical Center (Harvey, IL)
- …world-class academic healthcare system, Ingalls Memorial Hospital , as a Charge Master Analyst . This position will be primarily onsite. Join us as a Chargemaster ... Coding Analyst with our Shared Services - Revenue Cycle team...accurate CPT/HCPCS and revenue codes to CDM to insure compliance with regulatory agencies. Monitor and review daily revenue… more
- The University of Kansas Hospital (Des Moines, IA)
- …an inappropriate charge being utilized. Research billing guidelines to maintain CDM compliance with Medicare and Medicaid standards; reviews and updates ... Position Summary / Career Interest: The Charge Description Master (CDM) Analyst is responsible for maintaining and optimizing the hospital's Charge Description… more
- Gilead Sciences, Inc. (Foster City, CA)
- Sr. Analyst , Managed Care United States - California - Foster City Market Access & Health Economics Regular Gilead Sciences Inc. is seeking a Sr. Rebates Analyst ... managing Gilead's day-to-day administration and processing of all Managed Care Commercial/ Medicare Part D contract payments, in support of the contract development… more
- Rise Services Inc. (Arizona City, AZ)
- …who qualify. OVERVIEW AND ESSENTIAL JOB FUNCTIONS The Revenue Cycle Management (RCM) Analyst will use analytical skills and attention to detail to drive success. ... increase claims acceptance rates, particularly for claims submitted to Centers for Medicare and Medicaid services Develop and implement solutions to optimize the… more
- San Francisco Health Plan (San Francisco, CA)
- Reporting to the Director, Compliance and Oversight, the Health Plan Audit Analyst supports the San Francisco Health Plan (SFHP) Compliance Program through ... - $91,635 per year WHAT YOU WILL DO: Ensure compliance with regulations and controls by examining and analyzing...A minimum of five (5) years of experience in Medicare and Medicaid health care plan industry and operations… more
- San Francisco Health Plan (San Francisco, CA)
- …regional health care provider in San Francisco seeks a Health Plan Audit Analyst to support their Compliance Program through auditing and monitoring activities. ... a Bachelor's Degree and have at least five years of experience in the Medicare and Medicaid industry. The role supports a hybrid work model requiring in-office… more
- Prisma Health (Columbia, SC)
- …Clinical Quality Data, and Risk. Works collaboratively with data support specialist/ analyst and the Senior Infection Preventionist to coordinate data collection and ... acquired infections. Adheres to reporting standards as set forth by Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control (CDC) and other… more
- Molina Healthcare (Houston, TX)
- **(Sales) Compliance Analyst ** Molina Healthcare's Medicare Compliance team supports sales operations for the Molina Medicare product lines. It is a ... corporate function supporting compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Sales Compliance Analyst position is primarily responsible for Sales… more
- Humana (Boise, ID)
- …a part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... requirements development. + Creating and executing comprehensive test plans + Ongoing Medicare Pricer maintenance, quality assurance, and compliance + Determine… more
- Dana-Farber Cancer Institute (Brookline, MA)
- The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed Consent Forms, Clinical Trial Agreements, and other ... to patient insurance and which should be billed to the study sponsor.The Medicare Coverage Analyst determines whether proposed clinical research studies are a… more
- Corewell Health (Grand Rapids, MI)
- …of the member appeal and fair hearing review processes for all non- Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... systems, and collaboration to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory and accreditation requirements. Assist… more
- Geisinger (Danville, PA)
- …our team. The ideal candidate will have a strong understanding of Medicare settlement processes, compliance requirements, and hospital reimbursement regulations. ... data, identify trends, and prepare accurate accounting journal entries, ensuring compliance with federal and state guidelines. Proficiency in Microsoft Excel at… more
- Highmark Health (Pittsburgh, PA)
- …and technology experience + Operational improvement experience + Experience in Medicare or other Government lines of business **LICENSES OR CERTIFICATION** ... **Required** + None **Preferred** + Process Improvement certification (ie Lean, Six Sigma or Kaizan) **SKILLS** + Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields + Strong PC… more
- Highmark Health (Pittsburgh, PA)
- …and technology + Experience in operational improvement + Experience in Medicare or other Government lines of business. **LICENSES or CERTIFICATIONS** **Required** ... + None **Preferred** + None **SKILLS** + Broad application of principles, theories, and concepts in strategic thinking, plus working knowledge of other related fields + Strong PC application Skills (MS Office including PowerPoint and Excel) + Knowledge of… more
- Rush University Medical Center (Chicago, IL)
- …**Summary:** Reporting to the Manager of Compliance audit, the Corporate Compliance Regulatory Analyst plays a critical role in ensuring Rush University ... allegations. 2. Perform targeted reviews of documentation and billing to ensure compliance with Medicare Teaching Physician guidelines and conditions of payment.… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
