- Insight Global (Charlotte, NC)
- …drug events . Work with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage . Lead process ... partner with key business stakeholders. Key Responsibilities: . Analyze Medicare data , including PDE submissions, MMR reports,...to project yearly Medicare changes . Ensure data accuracy and compliance with CMS guidelines… more
- Molina Healthcare (Syracuse, NY)
- **Job Description: Director , Operational Oversight ( Medicare )** **Job Summary** Responsible for planning, developing and directing the implementation of ... and resolve. **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance , Healthcare Medical Claims Coding ... and report outcome results on edits implemented. + Utilize data to examine large claims data sets...public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity… more
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...accurate financial account setup. + Tracks and monitors census data to identify discrepancies and resolve issues impacting billing.… more
- Commonwealth Care Alliance (Boston, MA)
- …of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the ... Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in… more
- Houston Methodist (Katy, TX)
- …Access Services, and Utilization Review as needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid ... position provides guidance to staff and is responsible for staffing, budget compliance , contributing to staffing decisions such as hiring and terminating employment,… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical necessity ... care, prior authorization and denial management, education and provider support, and data and quality reporting for referrals for Medicare Advantage population… more
- Molina Healthcare (Caldwell, ID)
- …demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan, monitoring and reporting ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more
- Ankura (New York, NY)
- …, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment. The Senior Director ... following types of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance , audit, and investigation projects… more
- Trinity Health (Pensacola, FL)
- …Improvement Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance . The Director , Quality Improvement and Compliance , in ... including leading quality initiatives and projects. In addition, the Director ensures that data is collected from... with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance… more
- Humana (Montgomery, AL)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director … more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …us transform healthcare? Bring your true colors to blue. What we need The Associate Director of Clinical Data Management will be a key leader in executing ... clinical data management standards, processes, and procedures to ensure compliance with regulatory requirements and company policies. + Ensure the accuracy,… more
- City of New York (New York, NY)
- …recruiting for (1) Administrative Staff Analyst NM III to function as an Executive Director , Data Analytics & Verification who will: - Oversee the management, ... of Quality Assurance (OQA), Office of Accountability Strategies (OAS), Compliance and Contract Monitoring (CCM), Investigation, Revenue and Enforcement… more
- Humana (Raleigh, NC)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director … more
- Humana (Boise, ID)
- …part of our caring community and help us put health first** The Director , Internal Audit develops, plans and evaluates internal audit programs for the organization's ... and statistical records and the activities of various departments to ensure compliance with the organization's policies, procedures and standards. The Director ,… more
- University of Colorado (Aurora, CO)
- **Finance & Accounting Assistant Director ** **Description** **University of Colorado Anschutz Medical Campus** **Department: College of Nursing** **Job Title: ... Finance & Accounting Assistant Director ** **Position #:00706656 - Requisition #:36608** **Job Summary:** **Supervision Exercised:** **Examples of Work Performed:**… more
- Humana (Honolulu, HI)
- …those customers at the center of everything it does." The Associate Director , Sales Support oversees a team of contracting professionals. Their primary ... carriers for the Humana sales brokerage, Innovative Financial Group (IFG). The Associate Director , Sales Support requires a solid understanding of the Medicare … more
- Molina Healthcare (IA)
- …DESCRIPTION** **Job Summary** Lead operational readiness initiatives across provider data and credentialing functions, supporting both new implementations and ... successful launches of new processes, systems, and operational models across Medicaid, Medicare , and Marketplace lines of business. We are seeking a leader with… more
- Bristol Myers Squibb (Princeton, NJ)
- …+ Liaise with relevant points (CMM, Xavier, RxCrossroads, etc.) for budget coordination. Data Governance and Compliance : + Oversee data governance processes ... their personal lives. Read more: careers.bms.com/working-with-us . **SUMMARY:** The Associate Director , PASS Program Strategy and Marketing will play a critical role… more
- Corewell Health (Grand Rapids, MI)
- Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP) Long-Term Services and Supports (LTSS) is a senior leadership role responsible for ... the organization. As an organizational subject matter expert for LTSS, the Director will lead the development, implementation, and evaluation of high quality, cost-… more