- CVS Health (Cleveland, OH)
- …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 (Columbus, OH)
- …(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
- Bon Secours Mercy Health (Lorain, OH)
- …referrals to establish eligibility for care; understand and communicates Center for Medicare & Medicaid Services ( CMS ) medical necessity and admission criteria. ... The Admissions Coordinator RN cross trains to cover case management as needed, which includes initiating and directing the...on Accreditation of Rehabilitation Facilities (CARF), Joint Commission and CMS . Adheres to CMS , CARF and Joint… more
- Molina Healthcare (Cincinnati, OH)
- …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 (Akron, OH)
- …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
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Produces reporting and ... for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid). Integrates diverse data sources to report… more
- Trinity Health (Columbus, OH)
- …candidates will have a strong understanding of Medical claims particularly within Medicare guidelines. Researching claims that do not process as expected and ... overseeing any necessary configuration changes. Reviewing CMS notifications and assuring any necessary updates are done...to make sure they are set-up correctly in the system . Loading new codes into the system … more
- Humana (Columbus, OH)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Elevance Health (Mason, OH)
- …Senior** is responsible for analyzing and validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role involves ... data quality management processes and procedures. + Provide support for CMS audits and other regulatory reporting requirements. + Develop and analyze business… more
- OhioHealth (Columbus, OH)
- **We are more than a health system . We are a belief system .** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could ... financial reporting for clinical trials and research projects to provide system -wide support OhioHealth research activities. Activities include a variety of complex… more