- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …to align UM strategies and ensure compliance with CMS , DHCS, and Medicare Advantage program requirements. 2 . Case Management (CM): Support and guide ... Collaborate with health plan partners to align QI strategies and ensure compliance with CMS , DHCS, and Medicare Plan requirements. Work closely with the Quality… more
- Mindlance (Nashville, TN)
- …(eg, agencies, brokers). *Review submitted materials to ensure compliance with CMS Medicare Marketing Guidelines, applicable regulations, and MultiPlan brand ... compliance, or Medicare Advantage/PDP marketing review preferred. *Familiarity with CMS Medicare Marketing Guidelines and regulations. *Strong attention to… more
- Children's National Hospital (Silver Spring, MD)
- …Reimbursement Analyst will be responsible for preparing and filing the annual Medicare and Medicaid cost reports, audit support, third party settlement analysis, ... in the healthcare industry Required Skills/Knowledge Strong knowledge of Medicare and Medicaid reimbursement regulations for hospitals and/or physician payment… more
- Takeda Pharmaceutical Company Limited (Exton, PA)
- …Ensure submission of pricing information within the statutory time frames - Centers for Medicare & Medicaid Services ( CMS ), state agencies as required by statute ... Legal, and Internal Audit to ensure compliance with the Medicare Modernization Act of 2003, the Deficit Reduction Act...Improvement Act. Keep up to date on all applicable CMS releases relating to pricing calculations; Partner with Commercial… more
- Renown Health (Reno, NV)
- Position Purpose This position consistently applies the utilization management process as required by CMS including the use of designated criteria for primary ... review. Incorporates into the utilization management process the ability to access and interpret clinical...insurance plans, Medicare Advantage Plans, Centers for Medicare and Medicaid Services ( CMS ) and Division… more
- Optum (San Antonio, TX)
- …their inquiries. Routes calls to appropriate department if necessary Follows system scripting and validates member demographic information Documents the provider or ... appropriate Provides support to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject matter expert for… more
- Optum (San Antonio, TX)
- …inquiries. Routes calls to the appropriate department if necessary Follows system scripting and validates member demographic information Documents the provider or ... Provides support to internal staff, subcontractors and providers with respect to Medicare drug related issues Participates in and contributes to the overall pharmacy… more
- Pearl Health (New York, NY)
- …intelligence, and making care delivery more efficient and sustainable. The Center for Medicare and Medicaid ( CMS ) is launching a new value-based care program ... years of clinical experience in a healthcare setting in chronic care management , preferably for Medicare beneficiaries. Insurance experience preferred. Strong… more
- Optum (San Antonio, TX)
- …their inquiries. Routes calls to appropriate department if necessary Follows system scripting and validates member demographic information Documents the provider or ... appropriate Provides support to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject matter expert for… more
- USA Clinics Group (Northbrook, IL)
- …completing initial and subsequent credentialing packages as required by Medicare and Medicaid, commercial payers, hospitals, and regulatory agencies. Position ... provider's CAQH database file timely according to the schedule published by CMS Apply for and renew annually all provider licenses; Professional, DEA, Controlled… more
- CGS Administrators, LLC (Nashville, TN)
- …being met. Some travel between buildings and out of town. Centers for Medicare and Medicaid Services ( CMS ) Requirements: Certain divisions within BlueCross ... BlueShield of South Carolina require CMS (Centers for Medicare and Medicaid Services)...identify pertinent data needed to provide supporting documentation for system or operational enhancements/changes. Documents reporting procedures so other… more
- Top Tier Reps LLC (Chico, CA)
- …Drug Enforcement Agency (DEA) number or proof of application Meets Centers for Medicare & Medicaid Services ( CMS ) criteria to billMedicare Current AHA-HCP CPR ... hire Drug Enforcement Agency (DEA) number or proof of application Meets Centers for Medicare and Medicaid Services ( CMS ) to bill Medicare Credentialed… more
- Alignment Healthcare (Greensboro, NC)
- …enrollment kit fulfillment, certification and contracting/appointment requirements. 7. Ensures CMS compliance with all sales, enrollment processes and events. 8. ... managing relationships apprised of any updates and/or changes within department, CMS guidelines, company policies and procedures while keeping strong morale intact.… more
- Alternate Solutions Health Network (Kansas City, MO)
- …CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services ( CMS ), in collaboration with the Centers for Disease ... Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers. Based on this regulation, all of our employees must be… more
- Hallmark Business Connections (Kansas City, MO)
- …payers, knowledge of the Medicare Advantage market and familiarity with CMS five-star quality rating system . Experience in marketing automation, direct mail, ... close deals that help Healthcare payers improve member retention and Star ratings within Medicare Advantage and DSNP Plans. Your focus will be on driving new logo… more
- Blue Cross Blue Shield of Arizona (Phoenix, AZ)
- …job Develop recommendations for innovation to existing clinical services to improve management of medical utilization and costs and using data to design, develop, ... and support implementation of clinical operations management programs as approved by Clinical Excellence leadership to meet the demographic and epidemiological needs… more
- SCAN (Long Beach, CA)
- …member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, ... Specialist II is responsible for ingesting accurate provider data into SCAN's IKA system and ensures that all provider data related requests from the Medical Group… more
- MPAC Healthcare (Savoy, IL)
- …entrepreneurial spirit accompanied by strong medical knowledge, understanding of documentation ( CMS , Medicare , Medicaid) and nursing home/ hospital facility ... ongoing support Responsible for all documentation requirements and keeping up-to-date on Medicare Benefit and commercial insurance plans. Key Requirements - LCSW -… more
- Strategic Staffing Solutions (Detroit, MI)
- …HAS AN OPENING! Strategic Staffing Solutions is currently looking for a Business Analyst ( CMS Regulations / Risk) for a contract opportunity with one of our largest ... Analyst who can bridge regulatory requirements with operational execution across Medicare Advantage and other risk-bearing programs. The analyst will help ensure… more
- Trinity Health (Livonia, MI)
- …1-3 years of claims, adjusting, or billing experience preferred. Experience with Medicare reimbursement rules and CMS -1500 & UB-04 claims preferred. Previous ... with third-party billers. Manage fee schedules in the software system . Communicates with Interdisciplinary teams regarding unauthorized services. Submit enrollments,… more
