- Commonwealth Care Alliance (Boston, MA)
- …does not have direct reports. Essential Duties & Responsibilities: Regulatory Compliance & Monitoring * Monitor CMS and MassHealth regulations, bulletins, ... compliance with state and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role… more
- Fallon Health (Springfield, MA)
- …for people age 65 and older, who live in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Fallon Health (Worcester, MA)
- …of Coverage, and in compliance with applicable NCQA standards, CMS, MassHealth and other state or federal regulatory requirements. Strict adherence to ... representative. + Submit additional documentation if requested during or after the hearing. ** Regulatory Compliance ** + Ensure all appeal activities comply with … more
- East Boston Neighborhood Health Center (Revere, MA)
- …audits of provider documentation and coding practices for accuracy, completeness, and compliance with payer and regulatory guidelines. + Independently conduct ... laws, and regulations. + Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional… more
- Fallon Health (Lowell, MA)
- … regulatory requirements and Program policies and processes o Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
- Fallon Health (Worcester, MA)
- …FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
- Commonwealth Care Alliance (Boston, MA)
- …waste and abuse; suspected privacy and/or security incidents; or any compliance concerns identified + Ensures confidentiality of patient and company proprietary ... Medicaid Enrollment + If works in MA role requires MassHealth Enrollment + Candidate will be required to pass...to manage competing priorities + Familiarity with MA nursing regulatory scope and guidelines **Desired Knowledge, Skills & Abilities:**… more