- Idaho Division of Human Resources (Caldwell, ID)
- Medicaid Program Specialist - MED Posting Begin Date: 2025/10/30 Posting End Date: 2025/11/13 Category: Records Management Work Type: Full Time Remote: ... SOON AS POSSIBLE TO BE CONSIDERED.* The Division of Medicaid , Bureau of Care Management (BCM) has an exciting...team monitoring performance and customer care of a dynamic program that interacts with other IDHW programs, care providers,… more
- Cognizant (Boise, ID)
- …Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research ... **Member Appeals & Grievances Specialist ** (remote) This is a remote position open...and resolution of Medicaid provider appeals that will involve research of member… more
- Molina Healthcare (Meridian, ID)
- …managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program ), or medical office/hospital setting. + Completion of a ... Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist . This position is remote and will be working Pacific Standard hours. Highly Qualified… more
- Molina Healthcare (Meridian, ID)
- …managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program ), or medical office/hospital setting. + Completion of a ... Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work...and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Highly Qualified Applicants Will Have The… more
- HCA Healthcare (Caldwell, ID)
- …you want to join an organization that invests in you as aPatient Collections Specialist ? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- Prime Therapeutics (Boise, ID)
- …every decision we make. **Job Posting Title** Medication Therapy Management Specialist **Job Description** The Medication Therapy Management (MTM) Service ... Specialist is responsible for receiving inbound and making outbound...of business to review the benefits of the MTM program . This position speaks with members to gather and… more
- Molina Healthcare (Boise, ID)
- …managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program ), or medical office/hospital setting. * Completion of a ... accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the comprehensive… more
- Evolent (Boise, ID)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional ... implantable cardiac devices, etc) that do not initially meet medical necessity guidelines or require further evaluation by a...or sanction by any state or federal health care program , including Medicare or Medicaid , and is… more
- Molina Healthcare (Boise, ID)
- …(s) proficiency. **Preferred Qualifications** + Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), ... with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other… more
- CVS Health (Boise, ID)
- …every day. **Position Summary** Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that ... are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment...tools. + Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and… more
- Molina Healthcare (Boise, ID)
- …* Microsoft Office suite proficiency (including Excel), and applicable software program (s) proficiency. Preferred Qualifications * Certified Coding Specialist ... diagnosis-related group (DRG) validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and in accordance with… more
- Humana (Boise, ID)
- …the team as a Senior Product Manager working anywhere in the US. As a Specialist in NBA Execution, you'll play a hands-on role in translating strategy into real-time ... eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities **Our… more