- CVS Health (Harrisburg, PA)
- …initiatives to support audit readiness and collaborates with Compliance, Legal, Medicaid Health Plans, Network Contracting, and Provider Relations to ensure ... alignment with regulatory and contractual obligations. The Lead Director will also serve as a key liaison between Compliance, Legal, Network Contracting, and Provider Relations teams. **Required Qualifications** + A minimum of 7 years of healthcare payer… more
- CVS Health (Harrisburg, PA)
- …- 2 years leading member/customer service team. - Experience in a Medicaid and/or Medicare setting. **Education** - Bachelor's Degree or equivalent work experience ... **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $43,888.00 - $93,574.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which… more
- CVS Health (Harrisburg, PA)
- …for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team. Extensive claims research on multiple platforms to assist providers with ... payment questions. + Educate provider with related information to answer the unasked questions, eg, additional plan details, benefit plan details, provider self-service tools, etc. + Use customer service threshold framework to make financial decisions to… more
- Highmark Health (Pittsburgh, PA)
- …solutions with seamless omni-channel handoffs. As a key leader of the Medicaid Clinical organization, role is responsible for maximizing and optimizing value of ... the programs through delivery and as such, is accountable for customer activation, engagement, and experience, quality delivery, health outcomes, care cost management, and operational excellence/administrative cost management. This requires the incumbent to… more
- Highmark Health (Camp Hill, PA)
- …relations and contracting efforts. This encompasses a broad portfolio including Medicaid , TRICARE Dental Program (TDP), and Active Duty Program (ADDP) contracts. ... on expanding United Concordia's footprint and market share within the Medicaid market. **ESSENTIAL RESPONSIBILITIES** + **Strategic Planning & Development:** Develop… more
- Heritage Ministries (Conneautville, PA)
- …to complete all financial documents, explain billing procedures, and supervise the Medicaid process to ensure that the resident and/or responsible party fully ... the resident and/or responsible party. + Will assess when/if Medicaid assistance is needed. Explain the Medicaid ...when/if Medicaid assistance is needed. Explain the Medicaid process and provide a Medicaid application… more
- Humana (Harrisburg, PA)
- …may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials, internal teaching conferences, and ... Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and Medicaid requirements, and will understand how to operationalize this knowledge in… more
- Humana (Harrisburg, PA)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid /Medicare. Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid /Medicare. Looking for long-term improvements of encounter submission processes. Begins to… more
- Prime Therapeutics (Harrisburg, PA)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...Drug Rebate Program. + Ensures compliance with each State Medicaid contract. + Maintains rebate records in accordance with… more
- CVS Health (Swissvale, PA)
- …relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or ... contract coordination. + Performs credentialing support activities as needed. + Educates Medicaid providers as needed to ensure compliance with contract policies and… more