- Public Consulting Group (Harrisburg, PA)
- …+ Investigate complaints, initiatives and data packages against North Carolina (NC) Medicaid providers and conduct desk and routine reviews of assigned providers to ... letters, appeal summaries, etc. using standard templates. Communicate with NC Medicaid providers to obtain documentation, provide education as needed, and to… more
- Humana (Harrisburg, PA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Fresenius Medical Center (Harrisburg, PA)
- …+ Educates on the availability of alternative insurance options (ie, Medicare, Medicaid , Medicare Supplement, State Renal programs and COBRA). + Ensures patients ... options when insurance contracts are terminated. Responsibilities involving Medicare and Medicaid include but are not limited to: + Determining Medicare eligibility… more
- Humana (Harrisburg, PA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid , or other Medical management organizations, hospitals/ Integrated Delivery Systems, ... medical management review organization, such as Medicare Advantage and managed Medicaid . + Physical Medicine and Rehabilitation, Internal Medicine, Family Practice,… more
- Genesis Healthcare (Paoli, PA)
- …Cycle Management, which includes census, ancillaries, billing, adjustments, deposits, collections, Medicaid Pending and resident funds. The BOM must also have a ... 9. Monitors private spend down and timely conversions to Medicaid Pending; manages Medicaid Pending tracking and...and timely conversions to Medicaid Pending; manages Medicaid Pending tracking and all related processes including county… more
- WellSpan Health (York, PA)
- …Crowe RCA tool. Assists in preparation and filing of Medicare and Medicaid cost reports, therefore, must stay abreast of current governmental reimbursement ... projections. + Assists in coordination, preparation, and submission of Medicare and Medicaid cost reports using data from company general ledger and patient… more
- Highmark Health (Harrisburg, PA)
- …goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide ... share models and will be implemented for the Organization's Medicare Advantage, Medicaid , ACA, and commercial populations with the goal of maximizing quality while… more
- Humana (Harrisburg, PA)
- …other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the same day. ... years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through plans with benefits and… more
- Prime Therapeutics (Harrisburg, PA)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director, Pharm Trade Relations leads a team of directors ... Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as manufacturer and GPO negotiation,… more
- Humana (Harrisburg, PA)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
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