- US Tech Solutions (May, OK)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- US Tech Solutions (AZ)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- The Cigna Group (Bloomfield, CT)
- …is designed to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal ... role will assist in development of actuarial analyses for Medicare Part D business, including...Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting + Financial Reconciliation Modeling + Trend… more
- Prime Therapeutics (Oklahoma City, OK)
- …fuels our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** ... the coordination of benefits in the pharmacy program with Medicare Part D plans. Provides...and leadership skills that ensure successful Part D pharmacy operations and program compliance within… more
- CVS Health (Hartford, CT)
- …and Aetna's exciting and growing government services pharmacy business. The primary focus is the Medicare Part D product strategy and pricing of MAPD, SNP ... and PDP Products. This role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support to ensure… more
- Trinity Health (Gaithersburg, MD)
- … with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review and approval of ... time **Shift:** Day Shift **Description:** **Director, Quality, Improvement and Compliance ** **Location:** Trinity Health PACE of Montgomery County, Gaithersburg, MD… more
- CVS Health (Boston, MA)
- …Key Responsibilities: + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance ... The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … and its related financial models, including Medicare FFS, Medicare Advantage, Medicare Part D , and Medicare supplemental coverage. + Advanced ... by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of, we' d love… more
- Healthfirst (NY)
- …and following up on outstanding deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including tracking ... reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal...review of the website with business owners and ensures compliance with regulatory requirements specific to annual Go to… more
- BrightSpring Health Services (Louisville, KY)
- …the benefits of Original Medicare (Parts A and B) with prescription drug coverage ( Part D ). The Signature Advantage Plan is a unique plan allowing members to ... approved sales and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct… more
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for...the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards… more
- Central Maine Medical Center (Lewiston, ME)
- …staff and other department managers.c) Creates and sustains a culture of safety. d ) Leads and manages change effectively.e) Responds to change productively, promotes ... meeting the goals, communicate the plan to staff and evaluate the outcome. d ) Maximizes care efficiency and throughput.e) Responsible and accountable for fiscal… more
- Molina Healthcare (Boise, ID)
- …assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Analyst develops and ... analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures. * At… more
- Trinity Health (Farmington Hills, MI)
- …Vision, and Values in behaviors, practices, and decisions Performs daily activities as part of the billing and follow-up team in support of the revenue cycle ... applicable Federal, State, and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and… more
- Prime Therapeutics (Salt Lake City, UT)
- …(CHC) + Advanced degree in related area of study, such as Juris Doctor + Medicare Part D , Medicaid, and/or Affordable Care Act knowledge and experience ... fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal - Remote **Job Description** The Compliance Principal is… more
- Point32Health (MA)
- …Outlook). + Knowledge of Medicare Part B, C & D including HIPAA and compliance regulations **Working Conditions and Additional Requirements** (include ... areas of opportunity for the A&G department to reduce the risk of non- compliance with appeals and grievance requirements. These can include, but are not limited… more
- Prime Therapeutics (Frankfort, KY)
- …(CHC) + Advanced degree in related area of study, such as Juris Doctor + Medicare Part D , Medicaid, and/or Affordable Care Act knowledge and experience ... fuels our passion and drives every decision we make. **Job Posting Title** Compliance Analyst Principal (Performance and Oversight) - Remote **Job Description** The … more
- Dartmouth Health (Lebanon, NH)
- Overview Part time - 20 hours per week On Site - Lebanon, NH The Transplant Financial Coordinator reviews all new patient referrals for insurance suitability for ... counsels the patient in the application process for a wide range of Medicare , Medicaid and private insurance carriers. The Transplant Financial Coordinator also has… more
- Elara Caring (Fort Worth, TX)
- …Health, and Personal Care Services (PCS) agencies at Elara Caring to ensure compliance with Medicare and Medicaid regulations and billing rules. Areas of ... the Right Place. **Job Description:** **REMOTE POSITION** The Billing Compliance Auditor performs comprehensive audits within the Skilled Home...health journey, we care. Each team member has a part to play in this mission. This means you… more
- Adecco US, Inc. (Henderson, NV)
- …to clarify clinical information and explain determinations . Ensure compliance with Medicare Part D , Medicaid, and commercial plan guidelines . ... Collaborate with pharmacy technicians and medical directors on final decisions . Accurately document all cases and manage a high volume of reviews . Support cost-effective, safe, and evidence-based patient care **Requirements** . Bachelor's or Doctorate of… more