- CVS Health (Hartford, CT)
- …monitoring of Medicaid network compliance requirements, focused first on Medicaid credentialing and provider data tasks. The role will collaborate ... needs over time. + Medicaid network compliance of Medicaid credentialing and provider data tasks. + Collaborate with Legal and Compliance to… 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 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
- 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
- Idaho Division of Human Resources (Boise, ID)
- …External stakeholders include but are not limited to provider groups, provider associations, third-party contractors, other state Medicaid agency staff, and ... and projects. + Reconcile, audit, investigate and report on expenditures, budgets, provider reimbursement, and other financial data with internal and federal… more
- New York State Civil Service (Albany, NY)
- …identify targets.* Examine and analyze fee-for-service and managed care documentation to ensure provider compliance with the rules and regulations of the ... Description New York State leads the nation in developing a robust culture of Medicaid program integrity and healthcare compliance . Formed in 2006 to more… more
- New York State Civil Service (Albany, NY)
- …unique in the OMIG and the prepayment claims review function can be used as:-A provider compliance tool monitoring all or a portion of their activity-A tool to ... 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
- 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
- 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
- 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
- Highmark Health (Charleston, WV)
- …plan staff, to affect access to medical care and quality of medical care. + Provide input to HHO management on how provider network changes will affect member ... Advocate must collaborate with the Care Management Director and care coordinators, provide member support related to enrollment, access and continuity of care… more
- Humana (Richmond, VA)
- …implementations are involved + Be on point for the technology portion of all state Medicaid compliance audits. These will often tie back to the P&Ps noted here ... diverse scope and complexity ranging from moderate to substantial. The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships… 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
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Health, Department of Title Medicaid Eligibility Examiner 2 (SL) (HELPS) - 87301 Occupational Category Legal Salary Grade 14 Bargaining Unit ASU - ... reimbursement methodologies; performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies; inspecting, assessing,… 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
- Elevance Health (West Des Moines, IA)
- ** Medicaid Quality Management Health Planning Director** **Location:** This position will work a hybrid model (remote and office). Candidates must live within 50 ... miles of the Des Moines, Iowa office. The Medicaid QM Health Planning Director will be responsible for...including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives. **How you… more
- CVS Health (Richmond, VA)
- …Richmond, Virginia 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