- Prime Therapeutics (Richmond, VA)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Senior Medicare Claims Specialist - Remote **Job Description** The Claims ... satisfaction + Serve as the escalation point for Claims Specialist ; provide guidance and mentoring to ensure team member's...RxCLAIM + Experience in PBM industry + Experience with Medicare Part D + Experience using Microsoft Office products,… more
- Prime Therapeutics (Richmond, VA)
- …decision we make. **Job Posting Title** Medicare Health Plan Operations Specialist - Remote **Job Description** The Associate Functional Business Consultant ... PBM or healthcare experience + Experience using queries + Experience with Medicare Part D **Minimum Physical Job Requirements** + Occasional non-standard hours and… more
- CVS Health (Richmond, VA)
- …help to support various Scorable Action Items (SAI) programs in the Medicare population, including Fraud, Waste, and Abuse (FWA), Formulary Education, Therapeutic ... for: + Performing pharmacy reviews and making evidence-based recommendations regarding Medicare members + Identifying opportunities within the health plan for… more
- Highmark Health (Richmond, VA)
- …Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but ... (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment… more
- Merck (Richmond, VA)
- …with a driven, customer-focused, and collaborative team. As an Oncology Sales Representative/ Specialist , you will be a key member partnering with customers to ... Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more. **Qualifications:** **Minimum Requirements:** +… more
- Elevance Health (Richmond, VA)
- **Medical Management Specialist I** _Location:_ While remote , candidate must reside in Virginia and be ideally located within 50 miles of a PulsePoint. The ... **Medical Management Specialist I** is responsible for providing non-clinical support to...Capabilities and Experiences:** + Understanding of managed care or Medicaid/ Medicare strongly preferred. + For URAC accredited areas, the… more