- US Tech Solutions (May, OK)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- US Tech Solutions (AZ)
- …by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy… more
- CVS Health (Blue Bell, PA)
- …and Aetna's exciting and growing government services pharmacy business. The primary focus is the Medicare Part D product strategy and pricing of MAPD, SNP ... and PDP Products. This role will focus on developing health care solutions for Medicare Part D members. The colleague provides actuarial support to ensure… more
- Prime Therapeutics (Columbus, OH)
- …projects simultaneously **Preferred Qualifications** + Pharmacy Benefit Management/health care experience + Medicare Part D , Medicaid, and/or Affordable Care ... our passion and drives every decision we make. **Job Posting Title** Compliance Analyst - Medicare Part B- REMOTE **Job Description** Job Description The … more
- CVS Health (Scottsdale, AZ)
- …Medicare Pharmacy Audit Programs Project Manager you will be responsible for administering Medicare Part - D Pharmacy Audit Programs. In this role, you will ... make business-critical decisions and develop strategies to maximize client compliance integrity. You will utilize a wide variety of...using SQL coding analytics. + Coordinating the correction of Medicare Part - D claims and PDEs… more
- AmeriHealth Caritas (Philadelphia, PA)
- …This includes handling requests for decisions regarding denials of medical services and Part D drugs. ; **Key Responsibilities:** + Analyze and respond to ... the Supervisor of Appeals & Grievances and coordinates and performs all appeal-related duties within Medicare Advantage Dual Special Needs and Medicare -Medicaid.… more
- Kelly Services (Avon, CT)
- …and email with empathy, patience, and professionalism + Assist members with insurance claims, Medicare & Part D questions, and prescription issues + Serve ... **Now Hiring: Customer Service Representative ( Medicare Focused) | Temp-to-Hire Opportunity** **Location: Avon, CT...Week: 35-37.5 hours based on lunch choice + Training: Compliance training required **Perks That Set Us Apart:** +… more
- BrightSpring Health Services (Louisville, KY)
- …the benefits of Original Medicare (Parts A and B) with prescription drug coverage ( Part D ). The Signature Advantage Plan is a unique plan allowing members to ... approved sales and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct… more
- Northwell Health (Westbury, NY)
- …coding rules and regulations to the validation review process. + Reviews codes on Medicare /non- Medicare charts for compliance to rules and conventions. + ... Seeking RN - BSN or MSN candidates with a HCS- D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for...the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards… more
- Central Maine Medical Center (Lewiston, ME)
- …staff and other department managers.c) Creates and sustains a culture of safety. d ) Leads and manages change effectively.e) Responds to change productively, promotes ... meeting the goals, communicate the plan to staff and evaluate the outcome. d ) Maximizes care efficiency and throughput.e) Responsible and accountable for fiscal… more
- US Tech Solutions (May, OK)
- …exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information provided ... and Appeals Learning Advocates and management team as needed. + Must maintain compliance at all times with CMS and department standards. + Position requires schedule… more
- The Cigna Group (Austin, TX)
- …is designed to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal ... role will assist in development of actuarial analyses for Medicare Part D business, including...Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting + Financial Reconciliation Modeling + Trend… more
- VNS Health (Manhattan, NY)
- … with governmental regulations in this area. * Monitors premium billing to members for Medicare Part D . Analyzes monthly billing financials and works reports ... of data transfers. Monitors enrollment processing activities to ensure compliance to Center for Medicare and Medicaid...Accounts Payable to request payments as necessary. * Reviews Medicare Part D Prescription Drug… more
- Guthrie (Cortland, NY)
- …Provides leadership to the organization relative to the Clinical Regulatory Compliance program which assures the implementation and oversight of clinical ... requirements developed by the Center for Medicare and Medicaid (CMS), the Department of Health (DOH),...Commission (TJC). The primary purpose of the Clinical Regulatory Compliance Program is to ensure that the policies and… more
- Boehringer Ingelheim (Ridgefield, CT)
- …developing a comprehensive discount accrual forecasts and by providing support for Managed Care / Medicare Part D group efforts as required in order to ... Department, this individual will provide support to the Associate Director, Contract Compliance and the Director of Contract Development, as applicable, and as it… more
- CenterLight Health System (Rockaway, NJ)
- …to all relevant federal, state, and local laws, rules and regulations applicable PACE, Part D , LHCSA and Article 28 requirements, etc., through audits. The ... JOB PURPOSE: The Compliance Auditor will foster an environment that enhances...preferably in a Health Insurance Plan + Understanding of Medicare and Medicaid programs strongly preferred. + An in-depth… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … and its related financial models, including Medicare FFS, Medicare Advantage, Medicare Part D , and Medicare supplemental coverage. + Advanced ... by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you' d like to be a part of, we' d love… more
- AON (San Francisco, CA)
- …models to support regulatory compliance needs, including HCSO, PCORI, ACA Affordability, Medicare Part D , and Credible Coverage. Organize actuarial data ... compliance needs, including HCSO, PCORI, ACA Affordability, Medicare Part D , and Credible... compliance needs, including HCSO, PCORI, ACA Affordability, Medicare Part D , and Credible… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- … Medicare Prescription Drug Program, including compliance and oversight of Medicare Part D laws, regulations and reporting requirements, benefit ... Perform medical necessity reviews for formulary exceptions and prior authorizations according to the Medicare Part D defined guidelines + Work with the… more
- GEHA (Lee's Summit, MO)
- …Oversight & Performance Management** + Day to day management of the commercial PBM and Medicare Part D / EGWP administrator relationships for the FEHB and ... changes in pharmacy benefits implemented by the PBM, ensuring compliance and strategic alignment. **Regulatory Compliance &...Health Benefits (PSHB) along with those for CMS for Medicare Part D / Employer… more