- CGI Technologies and Solutions, Inc. (Baltimore, MD)
- …shortfall between purchase price and MFP. * Leverage knowledge of Medicare Part B and D claims processing and assist in designing an IT solution for ... to support the drug claims /rebate ecosystem. * Understand the US healthcare market, Medicare Part B and Part D processes, data flows, and pharmacy… more
- Medical Mutual of Ohio (OH)
- …(CPhT) preferred. . Knowledge of CMS guidelines and Medicare Part D (pharmacy). . Knowledge of pharmacy claims processing through retail or mail ... to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and...CMS guidelines and Medicare Part D (pharmacy). . Strong knowledge of pharmacy claims… more
- Mathematica (Washington, DC)
- …analyses and modeling of drug treatment exposure on healthcare outcomes using Medicare claims data (including Part D data) * Bring creative ideas to ... the development of economic and statistical models using administrative claims and other data sources. In particular, we are...sources. In particular, we are looking for individuals with Medicare Part D expertise who… more
- CGI Technologies and Solutions, Inc. (Baltimore, MD)
- …and payments. * Leverage knowledge financial ACH payment processing, preferable along Medicare Part B and D claims , and assist in designing an IT ... track of invoices and payment from pharmaceutical manufacturers to Part D and Part B...chargebacks and rebates, pertinent to prescription drug scripts and claims , is a plus. * PMP Certification is a… more
- CVS Health (Richmond, VA)
- …support staff working in the Therapeutic Duplication and Formulary Alternative Outreach Program for Medicare Part D Medications + Helping to support new or ... on identified cases for target medications + Analyzing data, claims , and clinical literature on appropriate utilization, making outreach... Medicare managed care experience + Experience with Medicare STARS and Part D … more
- InnovaCare (San Juan, PR)
- …members, during and after natural disasters. Through the Florida MMM Line of Care, as a Part D sponsor, you will ensure that the member has adequate access to ... DESCRIPTION Serves as primary liaison between MMM Health Care/PMC Medicare Choice, Government Health Plan (Vital) and any other...their covered Part D drugs. Orlando Family Physicians, a… more
- Centene Corporation (Raleigh, NC)
- …more of the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D / Part B, Appeals, Medicare ... and maintains formulary change requests to Health Net's pharmacy claims processor + Generates, maintains and reviews Formulary Status...for knowing and interpreting pharmacy and medical benefits. + Medicare Part D Operations +… more
- Conduent (Los Angeles, CA)
- … with corrections. + Required to have an understanding and working knowledge of Medicare Part A, B, C and D , including benefits and coverage. + Be able to ... Basic knowledge of insurance procedures, working with insurance carriers, Medicare , and Medicaid. + Required to have claims...of: + Medicare Part A, Part B and Part D … more
- CVS Health (Phoenix, AZ)
- …to support analytics - Quantifying the impact of legislative and regulatory changes in the Medicare Part D landscape- Developing various ad hoc analyses for ... experience working directly with healthcare client data analyzing pharmacy claims or other relevant data analysis * 1+ years...the Society of Actuaries) Preferred Qualifications * Experience with Medicare Part D , Medicare… more
- The Cigna Group (Bloomfield, CT)
- …These appeals will include requests for decisions regarding denials of medical services as well as Part B and Part D drug. The Appeals Specialist will be ... have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to differentiate different types of requests… more
- Martin's Point Health Care (Portland, ME)
- …the risk adjustment approach employed by CMS. + Prepare and analyze monthly estimates for Medicare Part D Risk Corridor and Coverage Gap Discounts. Perform ... support all Finance related Part C and Part D reporting requirements for Medicare...Lead analysis and calculation of incurred but not reported claims (IBNR). + Develop and maintain knowledge and expertise… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure ... successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via… more
- American Institutes for Research (MA)
- …Medicare payment policy, Medicare Advantage, and/or Medicaid. + Knowledge of Medicare claims , provider claims , survey data, and other publicly ... experience with federal agencies, including but not limited to the Centers for Medicare and Medicaid Services (CMS). Candidates hired for the position may work… more
- CVS Health (Tallahassee, FL)
- …research and data trends. Required Qualifications + 3+ years of Pharmacy Benefit Management, Medicare Part D or Medicaid experience. + 1+ years of ... currently include End-Stage Renal Disease (ESRD), Hospice, Transplant, Transition Fill and Part D Vaccine Administration. You will support CMS program audits… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …be responsible for strategic imperatives and tactical planning for targeted government channels: CMS, Medicare Part B MAC's, VA, DOD and Tricare East and West. ... commercial and government funded and experience in different access and reimbursement models, including Medicare Parts B and D , Medicare Advantage (eg, … more
- BrightSpring Health Services (Taunton, MA)
- …analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid ... PharMerica Overview Our Point of Sale Adjudicators are crucial to our 3rd Part Claims activities and our business. This is an excellent opportunity to move from… more
- CVS Health (Northbrook, IL)
- …work closely with multiple internal departments such as Sales, Account Management, IT, Medicare Part D Services, Client Audit, Benefits, and Implementations ... and affordable. Position SummaryThe Analyst, Commercial R&R role performs claims reverse and reprocessing (R&R) to address benefit coding...and plan design. RxClaim adjudication or benefits knowledge. + Medicare Part D - PBM… more
- CVS Health (Hartford, CT)
- …of all types of health care products including HMO, PPO, Medicare Advantage and Medicare Part D + Knowledge of all types of pharmacy products including ... analytical work requiring ability to capture, analyze and interpret claims data + Manage translation of business needs into...specialty drug, Medicare Part D and understanding… more
- Public Consulting Group (Augusta, ME)
- …pharmacists, and technicians representing various coverage plans + Educate MaineCare Members regarding various Medicare Part D plans and how to choose a ... plan pays benefits, etc. + Educate MaineCare Members on Medicare Savings Program/ Medicare buy-in plans and how...individuals/organizations. + Support roles dealing with all aspects of claims processing and customer service such as evaluating … more
- Bausch Health (Bridgewater, NJ)
- …compliance in regulated government/federal programs and price calculations (Medicaid AMPs, BPs, Medicare Part B ASPs, PHS 340B pricing & Non-FAMPs). Strong ... knowledge of current government program statutes and regulations including Medicaid, Medicare Part B, Federal Supply Program, Public Health Services/340B… more