- OhioHealth (Columbus, OH)
- …associated with revenue cycle, charge analysis, regulatory and financial reporting. * The Senior Reimbursement Consultant will be a subject matter expert in the ... This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities....well as the high level strategic purpose. * The Senior Reimbursement Consultant is required to use… 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 ... and under the direction of - the health plan, Medicare Compliance Officer, and other team members,...Medicare Advantage organization. + In partnership with other senior members of the team, assist with the oversight… more
- Humana (Oviedo, FL)
- …of our caring community and help us put health first** The Nurse Senior Stars Improvement, Clinical Professional/ Consultant contributes to the development, ... implementation, and management of the company's Medicare /Medicaid Five-Star Quality Rating System. The Senior ...Set (HEDIS), Patient Safety, and Patient Experience. The Nurse Senior Stars Improvement, Clinical Professional / Consultant … more
- Baylor Scott & White Health (Austin, TX)
- JOB SUMMARY The Third Party Compliance Consultant Sr performs ongoing activities related to the development, implementation, maintenance of, and adherence to ... a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance... Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and entities on … more
- Banner Health (AZ)
- …knowledge of laws and regulations pertaining to health care, regulatory compliance , Medicare /Medicaid and/or financial reimbursement systems. Must possess strong ... **Department Name:** Compliance -Corp **Work Shift:** Day **Job Category:** Compliance...This position interacts with a multitude of executive and senior management, physicians and staff throughout Banner depending on… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Senior Policy Consultant Location: Hybrid | Eagan, Minnesota Career Area: ... Blue Cross Blue Shield MN is looking for a Senior Policy Consultant to join our team....adviser for legislative, regulatory, and public policy initiatives impacting Medicare , Medicaid, and government programs. Working closely with internal… more
- MyFlorida (Tallahassee, FL)
- 68064926 - SENIOR INFO TECH BUSINESS CONSULTANT / TECHNICAL WRITER & COMMUNICATIONS Date: Sep 26, 2025 The State Personnel System is an E-Verify employer. For ... No: 861515 Agency: Agency for Health Care Administration Working Title: 68064926 - SENIOR INFO TECH BUSINESS CONSULTANT / TECHNICAL WRITER & COMMUNICATIONS Pay… more
- PruittHealth (Fayetteville, NC)
- **JOB PURPOSE:** The Nurse Consultant collaborates with the Senior Vice President Clinical Services and the hospice regional team to provide compliance ... program evaluation, education and monitoring functions to determine agency compliance with all regulatory groups and make recommendation/suggestions for improvement.… more
- Humana (Columbia, SC)
- …customers at the center of everything it does. The Growth Strategy Consultant (Distribution) provides data-based strategic direction to identify and address business ... support for the Enterprise Growth vertical. The Long-term Growth Strategy Consultant 's work involves moderately complex assignments performed with limited direction… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** This Senior Consultant , Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for ... active involvement in scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and… more
- Humana (Washington, DC)
- …Transformation Program team is a high-performing team that works closely with senior leaders to help chart the course for the company's future. Transformation ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Group ... standard formulas and actuarial information, recognizing system requirements and ensuring compliance with state and federal regulations, and adherence to internal… more
- CenterWell (Phoenix, AZ)
- …other providers to form a narrow network of quality service focused on senior population health + Responsible for medical interpretation, reviews, and decisions as ... the organization in community and marketing events. + Develop and maintain compliance with the departmental and physician budgets. + Assess, develop and recommend… more
- Humana (Olympia, WA)
- …caring community and help us put health first** Humana is seeking a Senior Responsible AI Data Scientist to champion the ethical development of artificial ... through collaboration with diverse stakeholders across the enterprise, including legal, compliance , education, and IT. In this role, you will contribute to… more
- Avera (Sioux Falls, SD)
- …you and our patients. Work where you matter.** **A Brief Overview** The Senior Coding Auditor is responsible for auditing technical and professional services. The ... on education and/or improvement plans. Emergent reviews may be performed based on compliance and clinical need. This individual will be required to understand and… more
- MetroLink (Los Angeles, CA)
- …of federal, state, regional, and local funding + Responsible for assuring compliance with federal and state regulations and guidelines through timely execution of ... appropriate + Ensure high-quality work output of departmental and consultant staff + Establish, monitor, and reinforce department policies...environment, with an emphasis on grants administration at a senior level. + Minimum of five (5) years of… more
- CenterWell (Savannah, GA)
- …Care Organization is one of the largest and fastest growing value-based care, senior -focused primary care providers in the country, operating over 340 centers across ... care team supporting patient's physical, emotional, and social wellness. At CenterWell Senior Primary Care we want to help those in the communities we… more
- CenterWell (Norfolk, VA)
- …other providers to form a narrow network of quality service focused on senior population health. + Responsible for medical interpretation, reviews, and decisions as ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally… more
- The Joint Commission (Oakbrook Terrace, IL)
- …from the field, analysis of periodic performance reviews, evidence of standards compliance reports, complaints, and Medicare out-of- compliance reports. + ... experience in orthopedics, and 2 years of accreditation or certification leadership or senior management experience. Recent experience as a consultant to health… more
- J&J Family of Companies (Santa Clara, CA)
- …and experience working with KOLs, physician specialty societies, sales teams and senior management. Reporting directly to the Sr. Director of Market Access and ... corporate objectives and payer dynamics. + Serve as a senior leader within the Market Access team, contributing to...internal cross-functional leaders (eg, Sales, Marketing, Medical Affairs, Legal, Compliance ). + Serve as a key point of escalation… more
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