- State of Minnesota (St. Paul, MN)
- **Working Title: Medicaid Payment Quality Assurance & Improvement Analyst** **Job Class: Human Services Program Representative 2** **Agency: Human ... Central Office + **Division/Unit** : Health Care Administration / Medicaid Payment and Provider Services + **Work...essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of… more
- CVS Health (Annapolis, MD)
- …is responsible for overseeing Medicaid claims operations, inventory management, quality assurance , and compliance monitoring. This role ensures timely and ... or state Medicaid agencies. + Knowledge of fee schedules, and Medicaid pricing methodologies. + Background in payment integrity, claims audits, configuration… more
- Humana (Little Rock, AR)
- …requirements development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance , and compliance + ... MS-DRG, etc). This role is within the Integrated Network Payment Solutions (INPS) department which falls under the Provider...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance , the Claims Sr. Analyst plays a critical role in ... the direction of the Director of Claims Operations and Quality Assurance , this role is responsible for...Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies… more
- NTT DATA North America (Albany, NY)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Senior Quality Assurance Analyst to join our team in Albany, New York ... required qualifications and high-level responsibilities for this NTT DATA position. **_Senior Quality Assurance Analyst_** The Senior Quality Assurance… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Specialist, Quality Assurance I is responsible for examining and evaluating the accuracy of transactions in accordance ... with Facets G6 **Knowledge, Skills and Abilities (KSAs)** + Basic knowledge of quality assurance and production technologies. + Proficient in Microsoft Office… more
- UPMC (Pittsburgh, PA)
- …productive team member is essential. - Knowledge of the National Committee on Quality Assurance (NCQA) Standards for the accreditation of managed care ... activity and supports various functions within the scope of the Health Plan Quality Improvement Program, working both independently and as a team member. The… more
- University of Rochester (Rochester, NY)
- …Delegate tasks in times of absence or high work volume and provide guidance and quality assurance of work. _Compliance_ + Review Medicare for MSP questions and ... that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal processes. Involves… more
- Educational Alliance, Inc. (New York, NY)
- …and improved service coordination across departments. + Conduct internal audits and quality assurance reviews of documentation, billing, and service delivery. + ... Social Work, or a related field. + 2+ years of experience in compliance, quality assurance , or program monitoring-preferably in a healthcare or social services… more
- Point32Health (Canton, MA)
- …will report to the Director of Risk Adjustment Strategy, Operations and Quality Assurance . **Job Description** + **Provider Consulting, Risk Score Reporting ... leading not-for-profit health and well-being organization dedicated to delivering high- quality , affordable healthcare. Serving nearly 2 million members, Point32Health… more
- Humana (Frankfort, KY)
- …submission errors. + Proven track record in implementing or overseeing data quality assurance processes and tools. + Experience working with external ... home in the state of California will be provided payment for their internet expense. + A minimum standard...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- AmeriHealth Caritas (Washington, DC)
- …plans to improve identified areas of concern; works with other departments to develop quality assurance initiatives based on survey results. + Supports the ... by AMC and Plan. + Ensures provider contracting is consistent with claim payment methodologies. + Maintains familiarity with State Medicaid fee schedules and… more
- Humana (Springfield, IL)
- …Center for Medicare and Medicaid Services (CMS) and the National Committee on Quality Assurance (NCQA). + Other job duties as assigned **Use your skills to ... until those dates to be eligible to receive the payment .** **Position Responsibilities:** + Utilize high- quality , evidence-based...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- State of Minnesota (Vadnais Heights, MN)
- …related to billing, coding, and documentation standards as well as managing the quality assurance processes to ensure accurate and timely billings. Primary ... all rules and regulations. + Reviewing coding and billing strategies while implementing quality assurance processes. + Understand charge master set up and manage… more
- Stark County Board of Developmental Disabilities (Canton, OH)
- …ISP's, and other documents as prepared by SSAs; + Develops and implements quality assurance routines to assure ISPs meet the highest standards prescribed ... as a coach/mentor for assigned SSAs; + Assures SSAs review and respond to Quality Assurance Review Recommendations; + Assures SSAs respond to requests for… more
- Houston Methodist (Katy, TX)
- …and appeal outcomes to identify risks and recommend improvements. + **Compliance & Quality Assurance ** + Ensure all audit activity complies with CMS, commercial ... cash collections, denials, avoidable write-offs, staff productivity and work quality and credit balances. The manager position responsibilities include managing… more
- Centene Corporation (Salem, OR)
- …improvement activities + Performs medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, or ... a leading provider of government-sponsored healthcare coverage, providing access to affordable, high- quality services to Medicaid and Medicare members, as well… more
- Centene Corporation (Raleigh, NC)
- … improvement activities. Performs medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, or ... a leading provider of government-sponsored healthcare coverage, providing access to affordable, high- quality services to Medicaid and Medicare members, as well… more
- Centene Corporation (Raleigh, NC)
- … improvement activities. Performs medical review activities pertaining to utilization review, quality assurance , and medical review of complex, controversial, or ... a leading provider of government-sponsored healthcare coverage, providing access to affordable, high- quality services to Medicaid and Medicare members, as well… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the ... of care. + May work with internal and external stakeholders for value-based payment programs, such as accountable cost and quality arrangements (ACQA). +… more