- Stanford Health Care (Palo Alto, CA)
- …Knowledge, Skills and Abilities** + Advanced knowledge of CMS and state Medicaid reimbursement principles and practices. + Multi-year skill and experience ... shaping the financial integrity of the organization. As a senior member of the team, this individual actively contributes...to ensure complete and accurate capture of all legitimate reimbursement opportunities. + Oversee Medicare and Medi-Cal… more
- Lyric (Newtown Square, PA)
- …Extensive demonstrated understanding of US health insurance payers including Commercial, Medicare , Medicaid (FFS and MCOs), third-party claims processing ... immigration support are not available for this position. The Senior Manager, Clinical Content Maintenance will serve as a...coding and claims edit logic (including NCCI, LCDs, State Medicaid , MUEs, Lyric edits and payer medical policies) +… more
- Wipfli LLP (Milwaukee, WI)
- …skilled nursing Medicare cost reports, understanding the skilled nursing Medicaid reimbursement systems for assigned states, assisting clients with cost ... is responsible for preparing cost reports and providing reimbursement consulting within the Senior Living space....reports + Gain an understanding of the skilled nursing Medicaid reimbursement systems for the assigned states… more
- Commonwealth Care Alliance (Boston, MA)
- …their impact on provider operations and satisfaction. - Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance ... and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards. - Lead initiatives to streamline provider… more
- Somatus (Mclean, VA)
- … reimbursement , health regulations, bonus methodologies, and financial structures across Medicare , Medicaid , and commercial payers. + **A clear communicator ... care?** Somatus is on the hunt for a visionary ** Senior Vice President of Finance** to lead at the...Time Off (PTO) + Professional Development, CEU, and Tuition Reimbursement + Curated Wellness Benefits supporting teammates physical and… more
- Commonwealth Care Alliance (Boston, MA)
- …Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare / Medicaid ) + Experience in health plan provider relations + Experience ... 011230 CA-Provider Engagement & Performance **Position Summary:** The Senior Provider Relations Specialist is responsible for building, maintaining and strengthening… more
- OhioHealth (Columbus, OH)
- …entities. * This position will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid ) reimbursement is received for OhioHealth. * ... cycle, charge analysis, regulatory and financial reporting. * The Senior Reimbursement Consultant will be a subject...assigned. * Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement and remaining… more
- Prime Healthcare (Ontario, CA)
- …seeking new members to join our corporate team! #LI-JV1 Responsibilities The Senior Medicare - Medicaid Biller/Collector is responsible for both billing ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- Prime Healthcare (Redding, CA)
- …and their family. For more information, visit www.shastaregional.com . Responsibilities The Senior Medicare - Medicaid Biller/Collector is responsible for both ... the specific payer guidelines, policies, procedures, and compliance regulations for Medicare - Medicaid . This includes maintaining the deficiency lists used to… more
- Humana (Little Rock, AR)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be ... Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG,… more
- AdventHealth (Altamonte Springs, FL)
- …of relevant experience in healthcare finance, preferably in reimbursement including Medicare , Medicaid reimbursement and regulatory cost reporting Strong ... Springs, FL **The role you will contribute:** This position leads AdventHealth's Medicaid reimbursement process across the entire company focusing on… more
- Humana (Nashville, TN)
- … Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
- Deloitte (Denver, CO)
- …consulting services to public sector clients + Support engagements focused on Medicaid reimbursement , including actuarial rate development across managed care ... and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk...Experience with risk adjustment mechanisms + Experience with Provider reimbursement streams (ie, DSH, UPL, etc.) + Experience with… more
- The Cigna Group (Bloomfield, CT)
- …Strong knowledge of the PBM industry and Government Regulated Programs such as Medicare , Medicaid , HCR + Strong communication skills, including presentations and ... and strategic direction you'll provide will better educate our Medicare clients on the products we offer and give...401(k) with company match, company paid life insurance, tuition reimbursement , a minimum of 18 days of paid time… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment,… more
- Humana (Miami Lakes, FL)
- …Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare , or both Medicare and Medicaid , achieve their best possible ... Sales Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Accura Healthcare (Omaha, NE)
- …laws and regulations pertaining to the position. QUALIFICATIONS: + Knowledge of Medicaid , Medicare , and insurance reimbursement systems, including billing ... Accura HealthCare has an opportunity to invite a Medicaid Billing Specialist - Lead to join our...growing accounting and finance team! We are a multi-state senior living organization and this position will reside out… more
- Erickson Living (Tinton Falls, NJ)
- Location: Seabrook Village by Erickson Senior Living We are hiring a Medicare Sales Agent, also known as our Health Insurance Resource Manager (HIRM). The HIRM ... 5 out of 5 stars from the Centers for Medicare and Medicaid Services, for 6 consecutive...+ Medical, dental and vision packages, including an annual reimbursement for qualified wellness expenses, personal health coaching and… more
- University of Southern California (Los Angeles, CA)
- …escalating complex issues to the Manager as needed. + Monitor and interpret CMS, Medicare , and Medicaid reimbursement , including proposed and final IPPS and ... This Senior Analyst of Government Reimbursement at...payment systems and cost reporting requirements. + Experience with Medicare and Medicaid reimbursement guidelines… more
- CareFirst (Baltimore, MD)
- …expertise in DC Medicaid reimbursement . + Knowledge of Maryland Medicaid and Medicare reimbursement . + Excellent verbal and written communication ... maintaining fee schedules for plans that utilize the DC Medicaid reimbursement schedules and methodologies. This position...may request to extend that knowledge across other Commercial, Medicare and Medicaid plans as needed. This… more
