- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... of supervisory experience and subject matter expertise in claims data processing review for the Medicaid and...review to meet requirements of the PERM program. + Provide guidance in determining state compliance with… more
- Guidehouse (Mclean, VA)
- …Will Do** **:** Guidehouse is seeking a motivated, passionate, organized, and detail-oriented Medicaid Data Senior Consultant to support the analysis of State ... Medicaid data . The ideal candidate will have...encounters, financials, etc.) and process to coach stakeholders on data compliance . + Maintains, tracks, and collaborates… more
- Humana (Richmond, VA)
- …provides strategic guidance for the development and implementation of Humana's Virginia Medicaid Compliance Program. The Compliance Officer is responsible ... Residency required The Senior Compliance Professional serves as the designated Compliance Officer for the Virginia Medicaid contract. The Senior … more
- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... strong supervisory experience and subject matter expertise in claims data processing review for the Medicaid and...+ Knowledge of payment systems and coding, billing and compliance rules; and + Knowledge of the Medicaid… more
- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... project management experience and subject matter expertise in claims data processing review for the Medicaid and...+ Knowledge of payment systems and coding, billing and compliance rules; + Knowledge of the Medicaid … more
- EssilorLuxottica (Mason, OH)
- Manager- Business Data ( Medicaid Reporting) Date: May 6, 2024 Brand: EyeMed Vision Care Location: Mason, OH, US, 45040 **Requisition ID:** 816990 **Position:** ... and hiring process. To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at ### (be sure to provide your name and contact… more
- New York State Civil Service (Albany, NY)
- …Description New York State leads the nation in developing a robust culture of Medicaid program integrity and healthcare compliance . Formed in 2006 to more ... program integrity functions. These positions include auditors, investigators, nurses, data analysts, pharmacists, other clinical/medical professionals, compliance … more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …statements; presents testimony at hearings; writes legislation. Reviews and analyzes complex data and system reports to ensure compliance with program ... accordance with the requirements of the Administrative Procedures Act. Implements Medicaid regulations directing provider participation standards and recipient… more
- Iowa Department of Administrative Services (State Of Iowa, IA)
- …Iowa. Iowa Medicaid establishes the state's policy to oversee performance and compliance of the Medicaid Managed Care program Under the general supervision ... ensure a successful transition to community-based service settings. This position will provide both consultative services and ongoing compliance monitoring for… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …hoc analysis. **How you'll spend your day** + Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter ... and review to ensure completeness of information received. Upload data into Medicaid systems and authorize transactions....for key findings and changes to state programs. + Provide backup for Medicaid team members in… more
- CVS Health (Hartford, CT)
- …term Care. In addition, this position will serve as a SME to all Medicaid LTSS RFP submissions and provide strategic guidance supporting initiatives across the ... Senior Medical Director, reporting to a Regional CMO of Medicaid , will collaborate with Aetna National Medicaid ,...in meetings and SME revisions with proposal writers and provide guidance to or participate in including orals presentations*… more
- State of Colorado (Denver, CO)
- Senior Assistant Attorney General I ( Medicaid Fraud) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4507605) Apply Senior Assistant Attorney ... General I ( Medicaid Fraud) Salary $106,309.00 - $140,000.00 Annually Location Denver,...Lead litigation teams comprised of attorneys, investigators, investigative auditors, data analysts, investigative nurse analysts, and paralegals at all… more
- PruittHealth (Norcross, GA)
- …of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to ... **JOB PURPOSE:** Supports the delivery of all Medicaid billing services by final/higher level auditing, correcting,...relevant accounts receivable. 3. Edits claim forms, using proper data element instructions for each payer, applying principles of… more
- New York State Civil Service (Albany, NY)
- …Office Suite and ability to learn new data systems. Knowledge of NYS Medicaid Compliance Program rules and regulations, specifically 18 NYCRR Part 521 Duties ... NY HELP Yes Agency Medicaid Inspector General, NYS Office of the Title...of the United States or its territories, you must provide independent verification of equivalency. This information can be… more
- Humana (Columbus, OH)
- …population with a strong lens on intersecting behavioral and social health needs. + Provide support to Medicaid markets within the region, aiding in case review, ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The...authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which… more
- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as… more
- CVS Health (Tallahassee, FL)
- …and affordable. Position Summary Responsible for increasing member and provider satisfaction, retention, and growth by efficiently delivering competitive services ... the overall supervision of Customer Service employees. Accountable for member/ provider satisfaction, retention, and growth by efficiently delivering competitive… more
- Humana (Nashville, TN)
- …meetings. + Develops service coordination policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices. ... Word, Excel, and PowerPoint. + Proficiency in analyzing and interpreting data trends. + Progressive business consulting and/or operational leadership experience. +… more
- Somatus (Mclean, VA)
- …management, member services, providers, etc., as well as external, (ie, provider /designated group contacts) in the evaluation, communication, outreach, and support ... of non-compliant members, providers, and groups + Provide education and training for staff + Compile various internal and external reports; obtain approval and… more
- Highmark Health (Columbus, OH)
- …and data analysis. Determines how decision support systems will provide information required to make effective business decisions; translates requirements into ... This job works closely with customers and design teams in prioritizing data and information requirements. The incumbent provides analysis in the development and… more