- 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
- US Tech Solutions (Linthicum, MD)
- …* 3+ years of healthcare experience * 2+ years' experience specifically with Medicaid / Medicare program operations * 1+ years' experience with Medicaid ... eligibility and remain a member in the ABHMD Managed Care Organization (MCO) Plan, by preventing or rectifying the...of healthcare experience * 2+ years' experience specifically with Medicaid / Medicare program operations * 1+ years' experience… 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
- Humana (Evansville, IN)
- …college or higher education + Experience with CGX + Experience with Medicaid / Medicare + Proficient utilizing electronic medical record and documentation programs ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Healthfirst (New York, 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
- Healthfirst (New York, NY)
- …explains program benefits in a manner that is compliant with the Center for Medicaid and Medicare Services (CMS) and company policies and regulations. This role ... The Medicare Outside Sales Representative is a top performing...health insurance coverage to avoid gaps or disruptions in care . Duties & Responsibilities : + Drive membership growth… more
- Elevance Health (Norfolk, VA)
- …Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative ... services to Medicaid plans in partnership with blue cross blue shield...background. Preferred Skills, Capabilities and Experiences: + Experience in Medicare and value base care as well… 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
- 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
- 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
- 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 (Richmond, VA)
- …member/ customer service team. Preferred Qualifications - Experience in a Medicaid and/or Medicare setting. Education Bachelor's Degree or equivalent work ... 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
- 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
- Healthfirst (New York, NY)
- …any changes/updates Minimum Qualifications: + High School Diploma or GED equivalent + Medicaid , Medicare , Commercial Sales, customer service, or retail ... This role serves as the key player in educating Medicare Advantage and Medicaid Advantage Plus (MAP)...Medicaid Services (CMS) and Healthfirst's policies. The Complete Care Specialist is a pivotal presence in the community… more
- LA Care Health Plan (Los Angeles, CA)
- …department and Plan Partners: Department of Health Services (DHS), Centers for Medicare and Medicaid Services (CMS) National Committee Quality Assurance (NCQA) ... Customer Solution Center Member Navigator II Job Category:...$75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created… more
- LA Care Health Plan (Los Angeles, CA)
- …investigated and resolved to the member's satisfaction in a manner consistent with LA Care , Centers of Medicare and Medicaid Services (CMS) and regulatory ... Customer Solution Center Appeals and Grievances Nurse Specialist...of experience in Clinical Nursing and 2 years in Medicare / Medicaid in a managed care… more