- Humana (Tallahassee, FL)
- …gaps. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality audits, prior ... clinical criteria. as appropriate works closely with Clinical Risk Management to support enterprise MD speaker readiness for external...and overseeing the plan for MD speaker engagement in CMS program audits** + Work closely with Clinical Risk… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The 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 analysis of data, and develops tools to… more
- Elevance Health (Tampa, FL)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... a BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an… more
- Ensono (Miami, FL)
- …Interchange (EFI), Next Generation Desktop (NGD), Electronic File Interchange (EFI), and the CMS Identity Management System (IDM). **Why Ensono?** Ensono is ... and FIPS 140-2, as applicable. + Maintain and renew certifications required for system access and management , ensuring continued compliance and eligibility. +… more
- BAYADA Home Health Care (Orlando, FL)
- …and accuracy as it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit ... Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS ...to Medicare Certified Offices with regards to CMS guidelines, Home Care Coding, PDGM guidelines and billing… more
- Molina Healthcare (Miami, FL)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Qualifications** **REQUIRED QUALIFICATIONS:** + Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical… more
- CVS Health (Tallahassee, FL)
- …of quality, sales effectiveness, retention, secret shopper initiatives, and state, federal, and CMS requirements for Medicare sales agents and programs + 0-3 ... and retain through the use of the Aetna IVL Medicare product portfolio.This role will deploy an operating model...integrated tech stack the call interactions, COIs, and lead management protocols with new and existing members. + Develop,… more
- CVS Health (Tallahassee, FL)
- …(if applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… more
- Molina Healthcare (St. Petersburg, FL)
- …with Medicare Advantage or Medicaid programs + Awareness of CMS audit processes or healthcare compliance requirements **Ideal Candidate Attributes** + **Curious ... Adjustment Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to...the generation of chart retrieval chase lists based on CMS audit samples and internal data logic. + Use… more
- Molina Healthcare (St. Petersburg, FL)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more