- Molina Healthcare (Racine, WI)
- …the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive research and ... coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- SSM Health (WI)
- …all government reimbursement services as assigned, including preparation of Medicare & Medicaid Cost Reports, Tricare Cost Reports, Wage Index, and handles audits ... requested to support filings. + Assists with compilation of data for annual Medicaid disproportionate share hospital surveys and audits. + Compile and submit annual… more
- Humana (Madison, WI)
- …of the appropriate courses of action. **Role Description:** Support Medicaid Implementations and Operations in electronic transmissions set-up for state ... while minimizing disruption and mitigating risks + Experience with Medicare and/or Medicaid + Ability to coordinate with development and user teams to assess… 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
- Marshfield Clinic (Wisconsin Rapids, WI)
- …+ Certified Application Counselor designation through the Centers for Medicare and Medicaid Services within three months from the first fall training offered after ... + Certified Application Counselor designation through the Centers for Medicare and Medicaid Services at time of hire. **Marshfield Clinic Health System is committed… more
- Humana (Madison, WI)
- …also lead the development of new products and services in Humana's Medicaid BH delivery model. **Position Responsibilities:** + Leads clinical and quality management ... **Preferred Qualifications** + Familiarity with Illinois -based BH organizations + Medicaid Managed Care clinical or behavioral health leadership experience + Reside… more
- Prime Therapeutics (Madison, WI)
- …client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other duties as assigned **Education & Experience** + Bachelor's ... within a highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must...study, such as Juris Doctor + Medicare Part D, Medicaid , and/or Affordable Care Act knowledge and experience **Physical… more
- Elevance Health (Waukesha, WI)
- …contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The **Audit and Reimbursement Senior** ... Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services).… more
- CVS Health (Madison, WI)
- …submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, ... (ICD) codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.… more
- Humana (Madison, WI)
- …states: California, Hawaii, Nevada, Oregon + Health Plan experience + Previous Medicare/ Medicaid Experience a plus + Call center or triage experience + Bilingual ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more