- Humana (Madison, WI)
- …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
- Marshfield Clinic (Marshfield, WI)
- …for billing, internal and external reporting, research and regulatory compliance activities. This individual accurately codes outpatient conditions and procedures ... as documented in the medical record and applying the ICD Official Guidelines for...Data Set (UHDDS) and assignment of the appropriate MS-DRG ( Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined… more
- Banner Health (WI)
- …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
- Humana (Madison, WI)
- …have comprehensive knowledge of processes, policies and procedures as well as compliance guidelines. Will support achieving operational and compliance key ... to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and… more
- Evolent (Madison, WI)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical… more
- J&J Family of Companies (Green Bay, WI)
- …support needs. + Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
- Humana (Madison, WI)
- …time with demonstrated advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The nature of the work ... concurrently navigating multiple computer applications. Due to the auto dialer process and compliance needs of the business there is limited day to day flexibility… more
- Humana (Madison, WI)
- …license in the state of residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability ... Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior… more
- Evolent (Madison, WI)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... and management staff, other CR's (Clinical Reviewers), providers, office staff and Field Medical Directors. **What You Will Be Doing:** + Functions in a clinical… more
- Highmark Health (Madison, WI)
- …related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, ... with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts… more