- Public Consulting Group (Madison, WI)
- …+ 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 (Madison, WI)
- …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
- Molina Healthcare (Milwaukee, WI)
- …relevant education and experience. + At least 3 years of Experience with Medicaid and/or Medicare. + Proven experience owning operational projects from concept to ... (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules. + Skilled in Excel and SQL, with the ability… more
- WestCare Foundation (Milwaukee, WI)
- …+ Maintain proper balance regarding source of payment (fee for service, Medicaid , public, private, and third-party payers) + Responsible for educating clients on ... on a timely basis. + Assist all clients with application process for Medicaid by assisting with completion of the application, addressing any questions or concerns… more
- Humana (Madison, WI)
- …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
- Humana (Madison, WI)
- …Department of Healthcare and Family Services (HFS) and Centers for Medicare & Medicaid Services (CMS) and Humana's Illinois locations. + This role is considered ... Department of Healthcare and Family Services (HFS) and Centers for Medicare & Medicaid Services (CMS) and Humana's Illinois locations for team engagement meetings. +… more
- Humana (Beloit, WI)
- …standards with some interpretation. **Key Responsibilities** + Visits Medicaid members in their homes, Assisted Living Facilities (ALFs), ... One (1) or more years of experience working with Medicare and Medicaid recipients, long-term care services, Home and Community-Based Services (HCBS), and/or managed… more
- Highmark Health (Madison, WI)
- …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
- Molina Healthcare (Kenosha, WI)
- …complaints. Works with enrollees and providers to facilitate the provision of Medicaid benefits and ensure enrollee's rights are upheld. Helps enrollees understand ... and members regarding community agencies, services and referrals for special needs, Medicaid in general, or other related needs. * Participates in the Statewide… more
- Molina Healthcare (Madison, WI)
- …director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other regulatory requirements. + Reviews quality referred issues, ... license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public… more