- Prime Healthcare (Ontario, CA)
- …actively seeking new members to join our corporate team! Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both billing and ... in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the… more
- Amazon (San Francisco, CA)
- …Program Leadership: - Lead initiatives to improve the quality of care delivered for Senior Health, as measured by HEDIS, Medicare Advantage Stars, ACO REACH, and ... Description We are seeking an experienced Clinical Quality Manager for Senior Health to join Amazon One Medical. Reporting directly to the National Leader for… more
- CVS Health (Hartford, CT)
- …Medicare knowledge **Education** . Bachelor's degree preferred/specialized training/relevant professional qualification **Pay Range** The typical pay range for ... with heart, each and every day. **Position Summary** Contributes to the Medicare Dental product portfolio, conducting market analysis and driving new product… more
- BrightSpring Health Services (Knoxville, TN)
- …Sales Account Representative/Executive for our Signature Advantage Plan who will work with senior care partners to assist in enrolling new residents and members. You ... will actively market our plan to new senior care partners within a plan service area. We...the plan and providing high quality customer service, providing professional , accurate and timely response to all inquiries regarding… more
- Prime Healthcare (Redding, CA)
- …their family. For more information, visit www.shastaregional.com . Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both billing ... in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the… more
- Fallon Health (Springfield, MA)
- …NaviCare program. + Participates in all community outreach activities, such as senior fairs, community events, and elder services professional association events ... area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare ...be made to tactical plans. + Manages their own professional development by seeking advice, training, and coaching from… more
- Humana (Lansing, MI)
- …Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional , and clinical activities for the purposes of pharmacy program ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Molina Healthcare (San Antonio, TX)
- …functional field of knowledge although they may have technical team members. Senior Program Management professional . Responsible for overall governance across ... needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management...implementation and compliance to AVP, VP and senior management + Consultative role, develops business case methodologies… more
- Mount Sinai Health System (New York, NY)
- …and Ancillary Contracts across the Mount Sinai Health System. MSHP seeks a Senior Contract Compliance ( Professional Billing) Analyst who will primarily ... compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team...be responsible for tracking, trending, and analyzing professional billing (PB) contract compliance issues. This… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Senior Quality Compliance Professional completes annual quality reviews and research. ... The Senior Quality Compliance Professional work assignments involve moderately complex...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Charleston, WV)
- …between Humana and its trading partners, Medicare and Medicaid. The Senior Encounter Data Management Professional will work with department leadership, ... caring community and help us put health first** The Senior Encounter Data Management Professional develops business...Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data and develops tools… more
- Highmark Health (Austin, TX)
- …Examiner (CFE) + Certified in Healthcare Compliance (CHC) + Certified Compliance and Ethics Professional (CCEP) **SKILLS** + Broad-based business knowledge ... This job is responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Senior Process Improvement Professional is an autonomous, strategic thinker that works across ... domains to create best business practices inside and outside of the Medicare Billing, Coordination of Benefits and Reconciliation organization. This professional … more
- Banner Health (AZ)
- …ready to change lives, we want to hear from you. Seeking an experienced compliance professional with knowledge of and experience in managing a Conflicts of ... knowledge of laws and regulations pertaining to health care, regulatory compliance , Medicare /Medicaid and/or financial reimbursement systems. Must possess strong… more
- Humana (Boise, ID)
- …to accelerate measure improvement efforts to improve HEDIS performance. The Senior Professional strategically identifies, develops, and implements programs that ... high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality...members or market leadership towards improved quality metrics. The Senior Professional work assignments involve moderately complex… more
- Humana (Olympia, WA)
- …providing frameworks to maximize available resources to achieve growth. The ** Senior Professional Business Intelligence Engineer** is an experienced individual ... a proven track record of leveraging data to meet compliance requirements and define and drive business value. The... requirements and define and drive business value. The Senior Professional will partner across various multi-disciplinary… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Senior Consumer Service Operations Professional is responsible for the daily activities across ... multiple service functions area. The Senior Consumer Service Operations Professional work assignments...in healthcare industry + **2+ years experience with Employer/Group Medicare plans** + Extensive experience in a corporate service… more
- Staffing Solutions Organization (Albany, NY)
- …workforce, which is a reflection of our clients and the people they serve. ** Senior Healthcare Program Specialist (Level 2 or 3) - Albany, NY** **Division of ... Eligibility & Marketplace Integration (DEMI)** **Bureau of Program Compliance and Audit** **50% Onsite 50% Remote** **Duties:** The Bureau of Program Compliance … more
- Humana (Albany, NY)
- …part of our caring community and help us put health first** The Senior Strategy Advancement Professional provides data-based strategic direction to identify and ... planning support for business segments or the company at large. The Senior Strategy Advancement Professional work assignments involve moderately complex to… more
- Baylor Scott & White Health (Dover, DE)
- …lessons are completed in a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance resource to BSWH ... JOB SUMMARY The Third Party Compliance Consultant Sr performs ongoing activities related to.... Proficient in Microsoft Word and Excel. . Demonstrates professional growth by obtaining continuing education and seeking certifications.… more
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