• Lundbeck (Waco, TX)
    …anticipate and effectively address payer access issues (IDNs, Medicare , Medicaid, Commercial) using Lundbeck resources. Pharmaceutical Environment/ Compliance ... - Apply knowledge of pharmaceutical and regulatory environment, including accountability and adherence to Lundbeck policies and procedures and FDA regulations regarding the promotion of pharmaceutical and medical products. REQUIRED EDUCATION, EXPERIENCE and… more
    HireLifeScience (07/29/25)
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  • Lundbeck (Fort Wayne, IN)
    …internal and external partners and effectively addresses payer access issues ( Medicare , Medicaid, Commercial) using Lundbeck resources. Local Market & Therapeutic ... patients including the full range of treatment options available. Pharmaceutical Environment/ Compliance - Ability to apply knowledge of pharmaceutical and regulatory… more
    HireLifeScience (07/29/25)
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  • Lundbeck (Joliet, IL)
    …anticipate and effectively address payer access issues (IDNs, Medicare , Medicaid, Commercial) using Lundbeck resources. Pharmaceutical Environment/ Compliance ... - Ability to apply knowledge of pharmaceutical and regulatory environment, including accountability and adherence to Lundbeck policies and procedures and FDA regulations regarding the promotion of pharmaceutical and medical products. REQUIRED EDUCATION,… more
    HireLifeScience (07/29/25)
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  • Novo Nordisk Inc. (WA)
    …as other Market Access & Public Affairs teams, Medical, Legal, Compliance , Communications and other key stakeholders locally and globally. External relationships ... Tax, Trade, Intellectual Property, Supply Chain, Private Health Insurance, Medicare , Medicaid, Reference Pricing, Pricing / Price Increases, Reimbursement, Privacy,… more
    HireLifeScience (06/03/25)
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  • Director, Medicare Compliance

    Molina Healthcare (Tacoma, WA)
    …relative to Molina Medicare . The Director will participate with the Molina Medicare Compliance Committee. The Director, working with the MHI VP Compliance ... , is accountable to the Molina Medicare Compliance Committee for all Medicare compliance related activities including but not limited to the development,… more
    Molina Healthcare (07/12/25)
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  • Medicare Compliance Manager…

    Molina Healthcare (ID)
    **Job Description** **Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and ... the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations. **Knowledge/Skills/Abilities**… more
    Molina Healthcare (07/25/25)
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  • Medicare Annual Wellness Visit Registered…

    SUNY Upstate Medical University (Syracuse, NY)
    …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
    SUNY Upstate Medical University (05/29/25)
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  • Medicare /Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    …reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics ... under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
    Commonwealth Care Alliance (05/28/25)
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  • Medical Director - Medicare Appeals

    CVS Health (Hartford, CT)
    …monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis * Develop ... Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part C...subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… more
    CVS Health (07/30/25)
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  • Senior Medicare Coverage Analyst

    Dana-Farber Cancer Institute (Brookline, MA)
    …of research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, ... fully remote with the ocassional time onsite as needed.** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed… more
    Dana-Farber Cancer Institute (05/18/25)
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  • Lead Sector Consultant Medicare Sales…

    Henry Ford Health System (Troy, MI)
    …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting...Information + Organization: HAP (Health Alliance Plan) + Department: Medicare & Individual Sales + Shift: Day Job +… more
    Henry Ford Health System (07/24/25)
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  • Attorney, Ethics and Compliance Division

    City of New York (New York, NY)
    …a variety of topics, including legal ethics, conflicts, privileges, federal grants, Medicare compliance , and outside employment. Division attorneys also conduct ... position of Assistant Corporation Counsel in the Ethics & Compliance Division. Attorneys with more than five years of...Senior Counsel position in the division. The Ethics & Compliance Division has counseling and ligation adjacent roles and… more
    City of New York (05/24/25)
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  • Sr Medicare Medicaid Biller Collector

    Prime Healthcare (Redding, CA)
    …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... For more information, visit www.shastaregional.com . Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both billing and collections,… more
    Prime Healthcare (07/25/25)
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  • Senior Medicare Medicaid Biller Collector

    Prime Healthcare (Ontario, CA)
    …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... new members to join our corporate team! Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both billing and collections, gathering and… more
    Prime Healthcare (05/28/25)
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  • Medicare /Medicaid Claims Reimbursement…

    Commonwealth Care Alliance (Boston, MA)
    Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in ... have direct reports. **Essential Duties & Responsibilities:** + Analyze MassHealth and Medicare claim reimbursements to ensure compliance with contractual terms,… more
    Commonwealth Care Alliance (05/31/25)
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  • Director, Operational Oversight ( Medicare

    Molina Healthcare (Albany, NY)
    …or related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with ... **Job** ** ** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM… more
    Molina Healthcare (07/29/25)
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  • Administrator

    Always Best Care Senior Services (Honolulu, HI)
    …to join our team. The ideal candidate will have a strong understanding of Medicare compliance requirements for Home Health and will help ensure our operations ... Qualifications: * Prior experience in a Home Health administrative role, preferably with Medicare compliance knowledge. * Strong familiarity with Medicare more
    Always Best Care Senior Services (05/07/25)
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  • Registration Specialist

    AdventHealth (Hinsdale, IL)
    …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) + standards and communicates relevant coverage/eligibility… more
    AdventHealth (07/18/25)
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  • Registration Specialist

    AdventHealth (Hinsdale, IL)
    …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
    AdventHealth (06/11/25)
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  • Program Operations Specialist 1 / Trainee…

    New York State Civil Service (Schenectady, NY)
    …Medicaid Compliance Unit (MCU) as it relates to ensuring Medicaid and Medicare compliance in Article 16 Clinics and for Independent Practitioner Services for ... Individuals with Developmental Disabilities (IPSIDD). - Research Medicare compliance requirements to develop protocols for reviewing clinical encounters and… more
    New York State Civil Service (07/24/25)
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