- CVS Health (Hackensack, NJ)
- …Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid and face a variety of complex health and social challenges. Through compassionate ... all necessary care covered by their benefit plans and available through Medicaid and community resources. . Build relationships with hospital social workers and… more
- Prime Therapeutics (Trenton, NJ)
- …or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible to work ... skills **Preferred Qualifications** + PBM/health care experience related to Medicare, Medicaid , Commercial, HIM + Certified Compliance and Ethics Professional (CCEP)… more
- Ascendis Pharma (Princeton, NJ)
- …accurate and timely payments, with a focus on government (Medicare, Medicaid , Federal) customers. + Cross-Functional Collaboration: Partner closely with Legal, ... and managing BPO service providers. + Familiarity with government pricing implications ( Medicaid , 340B, Medicare Part D) is a plus. + Excellent project management,… more
- Penn Medicine (Plainsboro, NJ)
- …authorization /referral requirements to have been completed. Refers patient to Medicaid Screener or Financial Counselor as needed. + Demonstrates flexibility and ... refers patient to Financial Counselor for assistance and/or refers patients for Medicaid Assistance. Ensures ABN is reviewed with patients, and signed document is… more
- J&J Family of Companies (Titusville, NJ)
- …Management (PBM) companies, Governmental Agencies (CMS and VA/DoD System), Medicare, Medicaid , Long Term Care (LTC) facilities, Integrated Delivery Networks (IDNs), ... outcomes-related knowledge to a diverse customer base, including MCOs, Medicare, Medicaid , Patient Advocacy, PBMs, GPOs, IDNs/Hospital Systems and LTC facilities .… more
- Elevance Health (Morristown, NJ)
- …performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an ... limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… more
- Humana (Trenton, NJ)
- …in a medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Current and ongoing Board Certification in ... leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- CVS Health (Trenton, NJ)
- …at quarterly state meetings. **Required Qualifications** - 1+ years' experience working with Medicaid . - 3+ years' in healthcare field working in fraud, waste and ... arbitrations, depositions, etc. **Preferred Qualifications** - Knowledge of New Jersey Medicaid - Credentials such as a certification from the Association of… more
- Care Plus NJ (Paramus, NJ)
- …patient accounts and reimbursement. The role requires strong knowledge of NJ Medicaid and Medicare billing, collaboration with clinical and executive teams, and ... education and experience + 2-3 yrs. experience working with all Medicare and all Medicaid plans; knowledge of NJMMIS and CMS required + 2-3 yrs. experience working… more
- Public Consulting Group (Trenton, NJ)
- …state, and local claiming requirements and guidance, especially Medicare and Medicaid . + Must understand coding guidance, including CPT (Current Procedural ... + Extensive experience in the full claim process particularly regarding Medicaid requirements. + Experience with MS-Office (proficiency in Word, Excel, PowerPoint).… more