- CareFirst (Baltimore, MD)
- …(strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid , and Federal Employee Health Benefits categories. Leads the ... performance, forecast sales and membership in line with growth objectives, in the Medicare Advantage Bid process annually, the cost and utilization of all benefits… more
- Highmark Health (Charleston, WV)
- …**Required** + None **Preferred** + None **EXPERIENCE** **Required** + 5 years in Medicare / Medicaid and risk revenue, primary care and the ambulatory ... improvement models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic,… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …+ Educate prospects on CPHL MAP product designed for Full Medicaid and Medicare recipients that need in home care and Long-term care services, ... in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company...by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application process… more
- Home Care Now (Clearwater, FL)
- …Required Qualifications: * Minimum two years of experience scheduling at private duty home care agency with Medicaid LTC / VA / Private payer sources. Experience ... to make a positive change in their career. Home Care Now's mission is to improve our client's lives...Medicare visit scheduling is a plus. * Excellent customer service and communication skills. * Knowlege of … more
- Commonwealth Care Alliance (Boston, MA)
- …improvement. + Minimum five (5) years of clinical experience in medical or behavioral health care delivery + Medicare and Medicaid managed care ... contractual performance standards. + Experience with managing clinical services for Medicaid / Medicare patients + Demonstrated knowledge of NCQA, federal and… more
- The Cigna Group (Bloomfield, CT)
- …experience in acute care , home health or case management experience. + Medicare and/or Medicaid experience with geriatric populations a plus + Certified Case ... nursing license required. **Position Summary:** Plans, implements, and evaluates appropriate health care services to assist the customer throughout the continuum… more
- Mathematica (Columbus, OH)
- …knowledge of administrative healthcare data (eg commercial claims, hospital claims, and Medicare or Medicaid (T-MSIS, TAF) data), healthcare informatics, or ... developing data-driven solutions that guide decision-making in US health care policy. This is a client-facing leadership role that...will eventually work with our largest client, Centers for Medicaid & Medicare Services (CMS). Most staff… more
- The Cigna Group (Bloomfield, CT)
- …compliant manner. Grievances coordinator position is focused on the processing of Medicare customer grievances. This associate may screen incoming complaints ... United States** The Grievance team manages Cigna Healthcare - Medicare / Medicaid grievances that are presented by our...care associates with three years of experience in customer service, call center or claims processing skills and… more
- Healthfirst (NY)
- … Medicaid and other entitlement program issues and on changes in Medicaid / Medicare /HMO laws and shares information with Care Team Social Work and other ... by yearly audit plan in the areas of Enrollment, Medicaid and Customer Service surveys; tracking of...+ 1 year of healthcare experience in Managed Long-Term Care (MLTCP), Medicaid or Medicare .… more
- Molina Healthcare (Glen Allen, VA)
- …3+ years supervisory/management experience in a managed healthcare environment. + Medicaid / Medicare Population experience with increasing responsibility. + 3+ ... a team of field Nurse Case Managers supporting our Medicaid program We are looking for someone with strong...assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term… more
- The Cigna Group (Bloomfield, CT)
- …service experience + Healthcare and/or call center experience + Preferred: Experience with Medicare / Medicaid If you will be working at home occasionally or ... **_Prior healthcare and/or call center experience required_** Delivers specific delegated Customer Service tasks assigned by a supervisor. Receives requests by mail,… more
- Humana (Tampa, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... 2) assumes ownership and leads advanced and highly specialized administrative/operational/ customer support duties that require independent initiative and judgment. +… more
- Guidehouse (Gardena, CA)
- …Job Functions** + Medicare Claims + Account Review + Appeals & Denials + Medicare / Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... **What You Will Do** **:** The **Insurance Patient Account Representative - Medicare Emphasis** is an extension of a client's business office staff. Representatives… more
- Houston Methodist (Katy, TX)
- …of compliance recommendations set forth by audits from Center for Medicare / Medicaid Services (CMS), other applicable regulatory agencies, and/or Houston ... Medicare compliance experience is preferred** **Note: Office for...Office for this position is located at our Continuing Care Hospital:** **701 S. Fry Rd. Katy, TX 77450**… more
- Fairview Health Services (Minneapolis, MN)
- …5-10 years' experience; health care setting preferred. + Solid understanding of Medicare and Medicaid rules of billing related to transplant services + ... regulatory and financial implications of the Transplant components of the Medicare Cost Report (MCR). **Responsibilities Job Description** The Sr Financial Analyst… more
- TEKsystems (Plano, TX)
- …Skills: Payment posting, Medical, Payment poster, Data entry, Medical billing, Medicaid , Collection calls, Revenue cycle, outpatient, wound care , physical ... Required: + 2-3 years of related experience in medical billing experience with Medicare + Have experience billing within one or more of the following specialties:… more
- CVS Health (Tallahassee, FL)
- …leading member/ customer service team. Preferred Qualifications - Experience in a Medicaid and/or Medicare setting. - Spanish Bilingual abilities are a plus ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- Somatus (Mclean, VA)
- …and ensure program compliance with governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with leadership ... Overview The Director, Medicare Risk Adjustment (MRA) will lead the execution...with knowledge of health plan operations ie Claim processing, customer service, enrollment etc. + Proven experience with commercial… more
- CVS Health (Fresno, CA)
- …relations; customer service or audit experience Preferred Qualifications -Some Medicare and/or Medicaid knowledge - Experience in reading or researching ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- BrightSpring Health Services (Arlington, TX)
- …you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization ... Non-retail/Closed-door environment Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation… more