- Serco (Washington, DC)
- …state Medicaid and CHIP fee-for-services (FFS) and managed care claims ; supporting state and national reporting; and development of corrective actions based ... of the PERM eligibility reviews, including eligibility review policies, business process; operations and contract deliverables, for estimating Medicaid and CHIP… more
- Humana (Columbus, OH)
- …+ Expertise in Medicaid and Medicare managed care + Expertise performing claims data analysis to inform VBP model design + Experience administering specialty VBP ... of our caring community and help us put health first** The Associate Director , Value-Based Solutions will be responsible for leading the operational performance of… more
- Serco (Washington, DC)
- …medical and claims reviews, including review policies, business process; operations and contract deliverables, for estimating Medicaid and CHIP eligibility ... **Position Description** Serco is seekinga motivated Assistant Program Director for Medical Claims Review to...Medicaid and CHIP fee-for-services (FFS) and managed care claims ; and supporting state and national reporting and development… more
- State of Indiana (Indianapolis, IN)
- …as stakeholder/participant technical assistance by: + Coordinating with the state Medicaid agency, stakeholders, and IDOE Legislative Affairs Director regarding ... transfers as necessary to pay participating school corporations' IndianaMAC claims and fund the state share of Medicaid...work experience in public health coverage programs policy or Medicaid program operations , or a related field.… more
- CareOregon (Portland, OR)
- …Nevada, Texas, Montana, or Wisconsin. Job Title Actuarial Services Manager - Medicaid and Medicare Exemption Status Exempt Department Finance Manager Title ... Director , Actuarial Services Direct Reports Actuarial Staff Requisition #...position is responsible for managing actuarial analysis related to Medicaid and Medicare Advantage lines of business with a… more
- Humana (Richmond, VA)
- …diverse scope and complexity ranging from moderate to substantial. The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships ... + **The CIO is dedicated full-time to the Virginia Medicaid product lines and must reside in the state...here on the previous bullet. + Collaborate with Market Operations /leadership in problem solving and help with workarounds as… more
- CVS Health (New York, NY)
- …and leading teams + Medicaid Network experience + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider ... Relations representatives (approximately 4) and reports to the local Lead Director . Oversees the maintenance of working relationships with the existing network… more
- Serco (Washington, DC)
- …state Medicaid and CHIP fee-for-services (FFS) and managed care claims ; supporting state and national reporting; and development of corrective actions based ... program management and subject matter expertise in health insurance eligibility and/or claims processing policy, particularly for the Medicaid and Children's… more
- Aveanna (Sarasota, FL)
- Home Health RN Executive Director Operations Full Time ApplyRefer a FriendBack Job Details Requisition #: 195409 Location: Sarasota, FL 34238 Category: Nursing ... for the administrative and leadership functions associated with all operations of an Aveanna branch. Additionally, this individual is...if internal billing and collection efforts to generate clean claims * Perform other duties as assigned Why Join… more
- University of Miami (Miami, FL)
- …processes for confidential and effective medical case review, peer review, and potential claims review. + Collaboration with Executive Director of Medical Risk ... in risk, compliance, strategy, governance, management, and health care operations , to achieve desired goals and results. CORE JOB...of the health care organization. + Collaboration with Executive Director of Claims and Litigation and keep… more
- Lancaster General Health (Lancaster, PA)
- **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical Director , ... Services of Lancaster General Health Physicians (LGHP) Hospitalists Program, overseeing operations and clinical quality for the consultative services and on-call… more
- Bausch Health (Bridgewater, NJ)
- …by required due dates and certification requirements. Oversight of Medicaid claims , Tricare and Coverage Gap processing operations with Third Party vendor ... validate against CMS calculated URAs in MDP prior to Operations team activating quarter within Medicaid system....within Medicaid system. Insure approval workflow of Medicaid , Tricare and Coverage Gap claims follows… more
- University of Washington (Seattle, WA)
- …applicable regulations such as the Stark law, Anti Kickback Statute, and the False Claims act. * The Director /AGC will have frequent written and oral ... pursuits and natural beauty. **UW Medicine has an outstanding opportunity for a Director of Clinical Regulatory Affairs and Associate General Counsel to join their… more
- Centene Corporation (Indianapolis, IN)
- …- Oversees staff to provide for the timely and accurate processing of Claims , Encounter forms and other information necessary for meeting Agreement requirements and ... and managing performance of staff. Managed care, insurance, Medicare or Medicaid experience preferred.Pay Range: $136,000.00 - $251,300.00 per year Centene offers… more
- Emory Healthcare/Emory University (Atlanta, GA)
- **Description** The ** Director , Net Patient Revenue** will take on a significant leadership role within Emory Healthcare to drive operational and financial ... receivable across Emory Healthcare for all hospital and physician billing operations . + Collaborate closely with financial planning and analysis, contract… more
- Prime Therapeutics (Columbus, OH)
- …that are the responsibility of the Vendor. Requirements: + Extensive knowledge of Medicaid and NMAP claims processing and pharmacy benefits management. + At ... fuels our passion and drives every decision we make. **Job Posting Title** Director , Clinical Account Services - Remote Nevada **Job Description Summary** Plays a… more
- City of New York (New York, NY)
- …Responsible for ensuring the accurate and timely submissions of Homebase, Anti-Eviction and Medicaid claims . Supervise the data and correction reports within a ... SQL algorithms and EDW data, analyzing data to identify claims that can be reclaimed for higher federal and...Administrative Staff Analyst NM-I to function as a Deputy Director of Single-Issue Review, who will: Supervise three analytical… more
- CVS Health (Richmond, VA)
- …to make health care more personal, convenient and affordable. Position SummaryThe Sr. Director of Value Based Payment Transformation (Sr. Director ) is a key ... the Department of Medical Assistance Services (DMAS). The Sr. Director will work in close partnership with the CEO,...all levels of the HCP-LAN framework.* 5+ years of Medicaid payor experience* 5+ years of developing and executing… more
- Lake Erie College of Osteopathic Medicine (Defuniak Springs, FL)
- Assistant Director of Patient Care Services - School of Dental Medicine Overview Date Posted: 2/1/2024 Location: LECOM Defuniak Springs Dental Clinic Address: 101 ... Full-time Description JOB SUMMARY: We are recruiting an Assistant Director of Patient Care Services for LECOM's Dental Outreach...the clinic; + Interface with IT staff on computer operations ; + Become proficient in axiUm software and train… more
- Lake Erie College of Osteopathic Medicine (Defuniak Springs, FL)
- …confidentiality of work related information and materials; + Interface, as needed, with the Director of Operations ; + Contribute directly to the Mission of LECOM ... Director of Patient Care Services - School of...the clinic; + Interface with IT staff on computer operations ; + Become proficient in axiUm software and train… more