- Prime Therapeutics (Madison, WI)
- …passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** Innovative business ... of the account, including P&L responsibility; and accountability for contract compliance .Accountable for developing and executing the strategic plan for their… more
- Molina Healthcare (Milwaukee, WI)
- …programs providing ongoing communication of goals, evaluation, and support to ensure compliance with standardized protocols and processes. + May engage and oversee ... years supervisory/management experience in a managed healthcare environment. + Medicaid /Medicare Population experience with increasing responsibility. + 3+ years of… more
- Humana (Baraboo, WI)
- …our caring community and help us put health first** Humana is seeking Case Manager , aka: Community Resource Coordinator (CRC), to join the Inclusa team to serve ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CVS Health (Madison, WI)
- …issues. + Manages operational aspects of the team (eg, budget, performance, and compliance ), and implements workforce and succession plans to meet business needs. + ... of 3 years managing/leading a team. + Experience working in Medicare, Medicaid , or Commercial Health Insurance. **Preferred Qualifications** + Experience working in… more
- Molina Healthcare (Madison, WI)
- …and supervision of daily functional operations to insure compliance to contract requirements. **Knowledge/Skills/Abilities** * Oversees budget responsibilities ... type management responsibility. 5 years progressive experience supporting a Medicaid ,.Medicare and Marketplace or large claims processing environment with… more
- Molina Healthcare (Milwaukee, WI)
- …our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role ... will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and regulatory guidance. The… more
- Molina Healthcare (Kenosha, WI)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met...that drive measurable improvement. + Partners with finance and compliance to develop business cases and support reporting that… more
- SSM Health (Fond Du Lac, WI)
- …Agnes Hospital **Worker Type:** Regular **Job Summary:** Coordinates regulatory compliance activities. Works collaboratively with leaders, clinicians and other staff ... meet regulatory requirements. Ensures implementation of an integrated regulatory compliance and accreditation program. **Job Responsibilities and Requirements:** PRIMARY… more
- Humana (Madison, WI)
- …other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the same day. ... in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required...to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through… more
- Elevance Health (Waukesha, WI)
- …specific understanding in end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare/ Medicaid regulatory policies regarding FFS and ... using RADV protocols and following Center for Medicare and Medicaid Services (CMS) and Affordable Care Act (ACA) rules....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more