- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... **Responsibilities:** + Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical Mutual's Medicare … more
- Dignity Health (Phoenix, AZ)
- …and compliance committee, on the status of Mercy Care Plan's Medicare compliance program implementation, the identification and resolution of potential or ... education and Five (5) years of experience that demonstrates solid Medicare compliance program development, operation andadministration responsibilities, upon… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …+ Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for all formulary-based findings. Supports and acts as ... is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes...upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to… more
- Sedgwick (Baton Rouge, LA)
- …Description** + Set up new Medicare Lien Resolution (MLR) referrals in the Medicare Compliance System + Electronically sort and index Medicare mail in ... the SIR and Medicare Compliance systems + Responds to questions from examiners about Medicare Compliance processes and products + Documents activity in… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Commonwealth Care Alliance (Boston, MA)
- …reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics ... under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
- Robert Half Office Team (Kansas City, MO)
- …possess strong sales skills, an entrepreneurial mindset, and a deep understanding of Medicare products and compliance standards. Could turn into a contract to ... * Active health insurance license is mandatory. * Comprehensive knowledge of Medicare products, enrollment timelines, and compliance policies. * Proven ability… more
- CVS Health (Hartford, CT)
- …monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis * Develop ... **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work on part C...subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… 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
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...Ensures documentation and billing practices align with audit and compliance expectations. + Escalates unresolved billing issues or delays… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, ... The Medicare Coverage Analyst (MCA) is responsible for reviewing...and which should be billed to the study sponsor.The Medicare Coverage Analyst determines whether proposed clinical research studies… more
- US Tech Solutions (May, OK)
- …company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. +...As a Pharmacist Advisor you will be directly supporting Medicare Part D members and providers with requests related… more
- Henry Ford Health System (Traverse City, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting...years of successful health insurance sales experience in the Medicare market. + Minimum of three (3) years of… more
- Hunterdon Health Care System (Flemington, NJ)
- …Promotes education for self and others by means of webinars and teleconferences offered by Medicare + General & Medicare Compliance : Medicare and Coding ... Responsible for application and maintenance of medical necessity software, insuring compliance relating to Medicare billing requirements, conducting internal… more
- Centene Corporation (Austin, TX)
- …and leads the identification, implementation, and maintenance of Duals and overlapping Medicare compliance policies, procedures and work instructions. + Leads ... fully remote. The ideal candidate will have experience or working knowledge of compliance laws and regulations, specifically related to Medicare , D-SNP, and… more
- CareFirst (Baltimore, MD)
- …(all benefits/incentives are subject to eligibility requirements). **Department** Medicare Compliance Office **Equal Employment Opportunity** CareFirst ... with, if applicable, corporate audit, HRD and the Corporate Compliance Office. Ensures that all Medicare and/or...the Corporate Compliance Office. Ensures that all Medicare and/or Medicaid requirements for training are met by… 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 ... Operating Procedures and Training documents. . Lead regularly scheduled Sales & Compliance leadership meetings. . Interpret and analyze Medicare , Medicaid, and… more
- Atlantic Health System (Morristown, NJ)
- …privacy, information governance, and data risk classification; (iv) accountable care organization compliance ; (v) Medicare C & D/ Medicare Advantage ... compliance program guidance; (iv) CMS Conditions of Participation; (v) Medicare Shared Savings Program Accountable Care Organization Compliance guidance and… more
- BayCare Health System (Clearwater, FL)
- …judgment at all times. **Minimum Qualifications:** **Experience:** + 5 years of Medicare compliance experience **Education:** + Required - Bachelors - Business; ... dignity, respect, responsibility and clinical excellence. **Summary:** + Assist the Chief Compliance Officer to continuously develop the Health Plans Compliance … more
- Point32Health (Canton, MA)
- …and direct administration of activities, projects, and personnel necessary to ensure compliance with Medicare , Commercial and Medicaid laws and regulations and ... research or equivalent combination of education and experience. 5+ years of Medicare and/or Medicaid Compliance experience. Strong experience with Medicare… more
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