- NYC Health Hospitals (New York, NY)
- …information and be familiar with claim coding practices and industry issues in Medicare payment methodologies. Advance level experience with Excel and other data ... comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care,… more
- Commonwealth Care Alliance (Boston, MA)
- …as necessary on all new and revised coding logic, related Medicare / Medicaid policies for review/approval through the Payment Integrity governance process. ... public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics +… more
- Commonwealth Care Alliance (Boston, MA)
- …and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports ... and fee schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate… more
- Molina Healthcare (Grand Island, NE)
- …Experience navigating Nebraska state and Medicare regulations related to claims configuration and payment accuracy. To all current Molina employees: If you ... of business analysis experience with an emphasis in claims payment accuracy and claims service recovery resolutions + 6+...Experience working with complex, often highly technical teams + Medicaid primary and Medicare preferable payer claims… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... all regulatory products. Responsible to reconcile the accuracy of payment file received from online premium payment ...P&P's + Serve as resource to other areas for Medicare and Medicaid questions/issues + Assists Management… more
- BeOne Medicines (San Mateo, CA)
- …+ Experience successfully launching new drugs across all government programs, knowledge of Medicaid and Medicare Parts B and D inflation rebates, line extension ... of BeOne's price reporting and contracting obligations under the Medicaid Drug Rebate Program (MDRP), 340B Drug Discount Program,... Drug Rebate Program (MDRP), 340B Drug Discount Program, Medicare Part B ASP Reporting, Medicare Part… more
- Molina Healthcare (Hartford, CT)
- …* This position plans, organizes, staffs, and coordinates the operations of state Medicaid , Medicare and Marketplace Health Plan operations. * Works with staff ... the functionality of Health Plan Operations. * Directly manages the Plan's benefit configuration , claim payment policies and the maintenance or modification of… more
- Molina Healthcare (Omaha, NE)
- …Information Management. **Job Duties** + Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, including ... bundled payments (APG, EAPG, APR-DRG, MS-DRG, etc.). This role is within the Configuration Solution Support team which falls under the Core Operations team for… more
- Stony Brook University (East Setauket, NY)
- …Managed Care payment variances and denials. + Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies. + Expert ... leader in the Hospital's Business Office to analyze, track, and pursue the payment of underpaid and denied accounts receivable. Successful candidates will have a… more
- Humana (Topeka, KS)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... of escalation in response to incidents/requests regarding network performance and configuration , including off hours escalations + Manage vendors and service… more
- McLaren Health Care (Flint, MI)
- …our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy ... Two (2) years' experience in claims and enrollment system configuration and maintenance. + Two (2) years' experience in... and maintenance. + Two (2) years' experience in payment integrity, claims editing and recovery operations. + Affiliation… more
- Humana (Sacramento, CA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... or lifecycle marketing experience + 2+ years of hands-on configuration experience with Adobe Journey Optimizer and Adobe Experience...Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide… more
- Molina Healthcare (Dayton, OH)
- …area to ensure accuracy of provider information in support of accurate configuration for claims payment . **JOB QUALIFICATIONS** **Required Education** Bachelor's ... in Business, Health Administration, or related field. **Preferred Experience** Experience with Medicaid and Medicare managed care plans. \#PJHPO \#LI-AC1 To all… more
- Humana (Annapolis, MD)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... analyze and evaluate variable factors such as network architecture, agent configuration , and detection capabilities. + **Strategic Collaboration** : Collaborate with… more
