- Staffing Solutions Organization (Albany, NY)
- …**Basic Qualifications:** + 10 years of professional experience + 5 years of subject matter expert experience + Supervisory experience **Desired ... reflection of our clients and the people they serve. ** Medicaid Program Advisor (Level 2 or 3) in Albany,...Executive Team** **50% Onsite / 50% Remote** **Summary:** The Medicaid Program Advisor will be part of an executive… more
- Neighborhood Health Plan of Rhode Island (Smithfield, RI)
- …act as the point of contact for claim related research. Serves as a claims subject matter expert (SME) and handles incoming inquiries regarding Payment ... but are not limited to: Acts as a claims subject matter expert (SME) and...Relations and Configuration teams. Monitor Centers for Medicare & Medicaid Services (CMS), Federal, State, industry standard, and software… more
- Stanford Health Care (Palo Alto, CA)
- …related to third-party liabilities and balance sheet reserves. + Serve as the subject matter expert on regulatory compliance reporting, including Medicare ... the Workday customer management model. + Serve as the subject matter expert for the...Medicare Auditor Contractor and strong familiarity with Medicare and Medicaid regulations. **Required Knowledge, Skills and Abilities** + Advanced… more
- PharmaCord (Lexington, KY)
- …need for prior authorization, appeal, tier exception, and/or formulary exclusions. Serves as a subject matter expert to internal team as required and ... issue resolution. Knowledge of healthcare compliance regulations, including HIPAA and Medicare/ Medicaid guidelines. Bi-lingual skills are a plus. We are located in… more
- Childrens Health System of Texas - TRINITY TOWERS (Dallas, TX)
- …for the system. Serve as a mentor to other Analysts on the team and a subject matter expert to other CHST departments. Complete financial impact analysis of ... input and updating EPIC reimbursement contracts. Stay abreast of all Texas Medicaid & Healthcare Partnership (TMHP), CMS and other governmental regulation changes… more
- Commonwealth Care Alliance (Boston, MA)
- …represent CCA to provider community and all constituents of CCA. + Serve as a subject matter expert within the department and company-wide for services ... compliance requirements. + Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services. + Conduct on-going assessments… more
- Genius Road (Austin, TX)
- …including performance metrics, pricing models, and evaluation criteria. Serve as a subject matter expert in workgroups, trainings, and operational ... manage solicitation packages including RFPs, RFQs, and RFIs. Facilitate collaboration with subject matter experts to ensure program-specific needs are accurately… more
- Stanford Health Care (Palo Alto, CA)
- …appropriate staff. Makes recommendations to management for corrective action. Serve as a subject matter expert and authoritative resource on interpretation ... state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance...and CPT coding updates, Coding Clinic guidelines; serves as subject matter expert and authoritative… more
- BeOne Medicines (Emeryville, CA)
- …price realization, and gross-to-net projections. + Serve as the policy and pricing subject matter expert , assessing implications of legislative and ... regulatory changes (eg, IRA negotiation, MFN, ASP reforms, Medicaid Best Price, AMP changes) and developing mitigation strategies. + Drive scenario planning,… more
- Commonwealth Care Alliance (Boston, MA)
- …liaison with external vendors + Facilitate Communications Team in content creation as the subject matter expert for provider network + Maintain inventory of ... foster strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This role ensures providers are well-informed, engaged,… more
- Stanford Health Care (Palo Alto, CA)
- …Medical Association (AMA) CPT Assistant. The SPC Coding Specialist II serves as a subject matter expert in hospital and professional coding, and interacts ... skills + Remain abreast of current Centers for Medicare and Medicaid Services (CMS) requirements, NCCI edits, National Coverage Determinations (NCDs), Local… more
- Commonwealth Care Alliance (Boston, MA)
- …**Required Knowledge, Skills & Abilities (must have):** + Strong claims experience + Mentoring subject matter expert of the team + Managed Care experience ... (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience with behavioral health providers preferred + Understanding of provider… more
- Stanford Health Care (Palo Alto, CA)
- …service line opportunity, and facilitate short and long-term resolutions. + Serve as a subject matter expert and authoritative resource on interpretation and ... Abilities** + Expertise in coding and CDI practices., maintaining expertise in Medicare/ Medicaid rules and regulations, as well as current trends and developments. +… more
- Stanford Health Care (Palo Alto, CA)
- …tools, goals, policies, and procedures for the Denials Management Department. Serve as a subject matter expert on billing and coding regulations and ... detailed review of medical records. Ensure compliance with Medicare, Medicaid , third-party guidelines, Local Coverage Determinations (LCD), National Coverage… more
- DATAMAXIS (Springfield, IL)
- …distance (3 - 5 Hours) of Springfield, IL. Functional Description: This position is a Medicaid Subject Matter Expert for the Illinois Enterprise Data ... Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations. * With the specialized… more
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for being the SME ( Subject Matter Expert ) for Medicaid risk adjustment programs in multiple states. ... available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment is not required. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze risk score… more
- Commonwealth Care Alliance (Boston, MA)
- …overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment ... - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid billing-related certifications **Required Experience (must have):** + 3+ years in healthcare… more
- Cayuse Holdings (WA)
- **Overview** The Health Exchange Subject Matter Expert (SME) will serve as a highly skilled and experienced consultant during the proposal phase. This ... Care Act (ACA) programs, including Qualified Health Plans and Medicaid . 1. **Skills and Competencies** 2. Strong expertise in...**Disclaimer** This job description outlines the responsibilities of the Subject Matter Expert during the… more
- AdventHealth (Altamonte Springs, FL)
- …regulations. **The value you will bring to the team:** + Serves as AdventHealth subject matter resource for Medicaid reimbursement matters. This role is ... in accounting and financial analysis Strong and proven leadership skills Expert in Medicaid program reimbursement laws and regulations Ability to research and… more
- CVS Health (Raleigh, NC)
- …Writer will develop strong work relationships with health plan leaders, proposal peers, and Subject Matter Experts (SMEs) to support business goals to win and ... win themes critical to generating business goals + Maintains expert understanding of Aetna Medicaid products and...goals + Maintains expert understanding of Aetna Medicaid products and services + Supports the content management… more
