- Humana (Harrisburg, PA)
- …analytics expertise, and a proven track record of leveraging data to meet compliance requirements and define and drive business value. The Senior Professional will ... analyze, synthesize, and present data related to benefit utilization, ensuring compliance with state reporting requirements and providing a comprehensive view of… more
- University of Pennsylvania (Philadelphia, PA)
- …and staff in the compliant fiscal conduct of all projects. + Ensuring financial compliance with institutional, federal and non- federal policy, rules and ... all sponsored projects expenditures including fund projections. Monitor and enforce compliance with sponsor guidelines and meet with Principal Investigators to… more
- Organon & Co. (Plymouth Meeting, PA)
- …Financial Planning and Analysis-US Commercial, will play a key role in ensuring compliance with federal and state government pricing programs, including Medicaid ... Drug Rebate Program (MDRP), 340B, Medicare Part B/D, and the Veterans Affairs (VA)/Department of...government pricing metrics (AMP, BP, URA, NFAMP, FCP) in compliance with applicable regulations. + Support monthly, quarterly, and… more
- Humana (Harrisburg, PA)
- …in reporting tools such as SSRS or SSIS + Knowledge of Medicaid or Medicare services + Advanced data analytics skills and reporting experience to include working ... Science, Statistics, or related field + Experience working with Medicaid and Medicare data + Expertise in creating analytics solutions to drive decision making… more
- Humana (Harrisburg, PA)
- …best practices, and design clinical solutions for members who have Medicare and Medicaid. The Lead Product Manager partners across various multi-disciplinary ... our dual members - members that qualify for both Medicare and Medicaid. The Lead Product Manager sits in...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Penn Medicine (Lancaster, PA)
- …development (GED) exam required. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie, ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...not excluded from participation in Medicare , Medicaid or any other federal or… more
- WellSpan Health (York, PA)
- …guidelines to optimize reimbursement for the system while ensuring compliance with applicable laws and regulations. **Duties and Responsibilities** **Essential ... HCPCS and ICD-10 codes as well as modifiers. + Conducts reviews comparing medical record documentation to validate charge capture, medical necessity, and coding… more
- Banner Health (PA)
- …you. **Requirements:** + **5 years recent experience in acute-care Inpatient facility-based medical coding (clearly reflected in your attached resume);** + **DRG and ... knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment… more
- UPMC (Pittsburgh, PA)
- …address Member identified needs through other sources, including services provided under Medical Assistance , Medicare or private insurance and other community ... provide for seamless coordination between physical, behavioral and support services. Ensures compliance with all state and federal regulations and guidelines in… more
- Aveanna Healthcare (York, PA)
- …applicable medical or religious exemptions. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in ... setting. Responsibilities include supervising staff, coordinating patient care, maintaining compliance , and supporting clinical excellence. Key Responsibilities: Care &… more
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