- Tris Pharma (Monmouth Junction, NJ)
- …reserve adjustments and other financial analysis. Perform analysis of sales, returns, Medicaid data , Managed Care data , chargebacks, wholesaler inventories ... and completion of financial closing activities in accordance, and in compliance , with Generally Accepted Accounting Principles (GAAP). Qualified candidate assists… more
- CVS Health (Hartford, CT)
- …monitoring of Medicaid network compliance requirements, focused first on Medicaid credentialing and provider data tasks. The role will collaborate ... + Medicaid network compliance of Medicaid credentialing and provider data ...prior to your first day of employment and to provide proof of your vaccination status or apply for… more
- Humana (Columbus, OH)
- …technologies, applications, and practices used to collect, integrate, analyze, and present the Medicaid segment's compliance data to solve complex business ... data more efficiently within the segment to manage compliance risk needed to support current Medicaid ...used only if approved by leadership. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment… more
- CVS Health (Richmond, VA)
- …incumbent will support the Lead Director in the ongoing maintenance and management of Medicaid compliance data and reporting in the CVS Health governance, ... new requirements to validate completion + Maintain documentation and data within the designated project management and tracking tools...areas of responsibility. + Work across members of the Medicaid compliance team and growth partner business… more
- Humana (Columbus, OH)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... Engineer will be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities. They will… more
- HCA Healthcare (Brentwood, TN)
- …and billing errors, utilizing proper customer service protocol + Update and maintain data in appropriate Provider Enrollment systems while ensuring accuracy and ... needed + Work with payors and providers to ensure compliance with enrollment process + Initiate contact with payors...GED preferred + 1 year of related experience in Medicaid Enrollment, Managed Care Enrollment, or Provider … more
- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... of supervisory experience and subject matter expertise in claims data processing review for the Medicaid and...review to meet requirements of the PERM program. + Provide guidance in determining state compliance with… more
- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... strong supervisory experience and subject matter expertise in claims data processing review for the Medicaid and...+ Knowledge of payment systems and coding, billing and compliance rules; and + Knowledge of the Medicaid… more
- Serco (Washington, DC)
- …state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP ... project management experience and subject matter expertise in claims data processing review for the Medicaid and...+ Knowledge of payment systems and coding, billing and compliance rules; + Knowledge of the Medicaid … more
- EssilorLuxottica (Mason, OH)
- Manager- Business Data ( Medicaid Reporting) Date: Apr 7, 2024 Brand: EyeMed Vision Care Location: Mason, OH, US, 45040 **Requisition ID:** 816990 **Position:** ... and hiring process. To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at ### (be sure to provide your name and contact… more
- Idaho Division of Human Resources (Boise, ID)
- …External stakeholders include but are not limited to provider groups, provider associations, third-party contractors, other state Medicaid agency staff, and ... and projects. + Reconcile, audit, investigate and report on expenditures, budgets, provider reimbursement, and other financial data with internal and federal… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …statements; presents testimony at hearings; writes legislation. Reviews and analyzes complex data and system reports to ensure compliance with program ... accordance with the requirements of the Administrative Procedures Act. Implements Medicaid regulations directing provider participation standards and recipient… more
- CareOregon (Portland, OR)
- …trends, competitive analysis, and drivers of revenues and expenses. + Provide Medicaid rate setting support through data analysis, policy review and strategy ... Nevada, Texas, Montana, or Wisconsin. Job Title Actuarial Services Manager - Medicaid and Medicare Exemption Status Exempt Department Finance Manager Title Director,… more
- CVS Health (Hartford, CT)
- …term Care. In addition, this position will serve as a SME to all Medicaid LTSS RFP submissions and provide strategic guidance supporting initiatives across the ... Senior Medical Director, reporting to a Regional CMO of Medicaid , will collaborate with Aetna National Medicaid ,...in meetings and SME revisions with proposal writers and provide guidance to or participate in including orals presentations*… more
- Louisiana Department of State Civil Service (New Orleans, LA)
- …and/or state policies and regulations, which affect allowable costs. Coordinates compliance monitoring of Medicaid Application Centers statewide. Receives, ... MEDICAID PROGRAM MONITOR Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4485275) Apply MEDICAID PROGRAM MONITOR Salary $4,177.00 -… more
- PruittHealth (Norcross, GA)
- …of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to ... **JOB PURPOSE:** Supports the delivery of all Medicaid billing services by final/higher level auditing, correcting,...relevant accounts receivable. 3. Edits claim forms, using proper data element instructions for each payer, applying principles of… more
- Humana (Richmond, VA)
- … Medicaid Market, developing a deep understanding of Humana's Medicaid strategy, capabilities, business drivers, data analytics infrastructure, operational ... the strategic management and oversight of financial operations for Humana's Virginia Medicaid Plan, and oversees the budget, financial reporting, and all audit… more
- Humana (Richmond, VA)
- …implementations are involved + Be on point for the technology portion of all state Medicaid compliance audits. These will often tie back to the P&Ps noted here ... diverse scope and complexity ranging from moderate to substantial. The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships… more
- Highmark Health (Columbus, OH)
- …programs as necessary; may have budgetary responsibility and authority. + Provide leadership for data analysis, including requirement solicitation, collaboration ... **Company :** enGen **Job Description :** **JOB SUMMARY** The job understands healthcare data end-to-end and oversees the analysis and delivery of analytic data … more
- Humana (Columbus, OH)
- …population with a strong lens on intersecting behavioral and social health needs. + Provide support to Medicaid markets within the region, aiding in case review, ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The...authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which… more
