- Prime Therapeutics (Madison, WI)
- …member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the client regarding ... experience + Knowledge of the applicable line of business (eg, Medicare, Medicaid , Exchange, Commercial, Employer Group) Every employee must understand, comply with… more
- Molina Healthcare (Racine, WI)
- …and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution ... coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Humana (Madison, WI)
- …Segment team is an entrepreneurial, multi-functional team within Humana's Medicare and Medicaid business unit. The team is focused on driving industry leading ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Molina Healthcare (Green Bay, WI)
- …automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid , Marketplace and Medicare/MMP. + Analysis and reporting related to Managed ... Review tracking, Interventions tracking for at least one line of business among Medicaid , Marketplace and Medicare/MMP. + 3+ Years of experience in working with… more
- TEKsystems (Brookfield, WI)
- …responsibilities as assigned. Skills claims processing, claims adjudication, call center, medicaid , Coding Top Skills Details claims processing Additional Skills & ... using QNXT (TM) Claims Workflow a plus Prior experience with ACA, Medicaid , or similar health plans preferred. Coding experience preferred. Experience Level… 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 III** ... Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services).… more
- TEKsystems (Milwaukee, WI)
- …and/or agency as needed. Skills claims processing, claims adjudication, call center, medicaid , Coding Qualifications + High school diploma or equivalent preferred. + ... using QNXT (TM) Claims Workflow a plus + Prior experience with ACA, Medicaid , or similar health plans preferred not required + Coding experience preferred not… more
- Prime Therapeutics (Madison, WI)
- …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
- Humana (Madison, WI)
- …residence + Eligibility to participate in federal prescription programs (eg, Medicare/ Medicaid ) + Self-directed with the ability to work effectively both ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Elevance Health (Waukesha, WI)
- …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