- Lundbeck (Santa Monica, CA)
- …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
- Lundbeck (Fort Collins, CO)
- …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
- Lundbeck (New York, NY)
- …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
- Genmab (Berkeley Heights, NJ)
- …voice of Genmab to our customers and will maintain the highest quality and compliance to provide a positive experience. This position reports to the Patient Services ... and oral) product reimbursement, including but not limited to Medicare , Medicaid and commercial insurance carriers, Prior Authorization submissions/appealsUnderstanding… more
- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... **Responsibilities:** + Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical Mutual's Medicare … more
- CVS Health (KS)
- …And we do it all with heart, each and every day. **Position Summary** The ** Medicare Compliance Consultant** is a compliance role that supports the ... partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop and… more
- Insight Global (Charlotte, NC)
- …Subsidy allocations . Work with Finance and Account Management to project yearly Medicare changes . Ensure data accuracy and compliance with CMS guidelines ... with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage ....IT, Account Management, and Compliance to optimize Medicare data usage . Lead process improvement through developing… more
- Ochsner Health (New Orleans, LA)
- …as resource to company employees and management in applying and improving compliance policies, procedures and processes. Perform Medicare Coverage Analysis (MCA) ... system. + Creation, revision, and management of documents related to Medicare coverage analysis and compliance with Medicare rules and regulations + Meet… more
- 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
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director, Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational ... compliance with state and federal healthcare regulations, particularly MassHealth...federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims… more
- CVS Health (CT)
- …highly regulated function, this role will also oversee delegated PBM functions, cross Medicare Pharmacy Organizational Compliance with CMS regulations as well as ... implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of… more
- 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
- CVS Health (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
- Insight Global (Pleasanton, CA)
- … Medicare claims for outpatient mental health services. This role ensures compliance with Medicare regulations and supports the clinic's financial health ... services. * Apply correct CPT, HCPCS, and ICD-10 codes in compliance with Medicare rules. * Ensure documentation meets "medical necessity" requirements. * Track… more
- US Tech Solutions (May, OK)
- …company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent… more
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...Ensures documentation and billing practices align with audit and compliance expectations. + Escalates unresolved billing issues or delays… more
- 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, ... any state in the US (except Hawaii).** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical...which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies… more
- US Tech Solutions (May, OK)
- …company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. +...As a Pharmacist Advisor you will be directly supporting Medicare Part D members and providers with requests related… more
- Highmark Health (Harrisburg, PA)
- …A key responsibility is the creation, revision and management of spreadsheets related to Medicare coverage analysis and compliance with Medicare rules and ... Health Network **Job Description :** GENERAL OVERVIEW: Responsible for the Medicare Coverage Analysis (MCA) for sponsored projects within WPAHS, budget development… more
- Centene Corporation (Austin, TX)
- …and leads the identification, implementation, and maintenance of Duals and overlapping Medicare compliance policies, procedures and work instructions. + Leads ... Duals and SMAC regulatory filings. + Manages Duals (and Medicare with D-DSNP specific or separate) compliance ...(and Medicare with D-DSNP specific or separate) compliance reporting responsibilities and respond to inquiries from state… more
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