- 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
- Humana (Madison, WI)
- …in a medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Current and ongoing Board Certification in ... leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Public Consulting Group (Madison, WI)
- …state, and local claiming requirements and guidance, especially Medicare and Medicaid . + Must understand coding guidance, including CPT (Current Procedural ... + Extensive experience in the full claim process particularly regarding Medicaid requirements. + Experience with MS-Office (proficiency in Word, Excel, PowerPoint).… more
- Humana (Madison, WI)
- …Guidance on following and reviewing home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and ... leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Humana (Madison, WI)
- …Guidance on following and reviewing home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and ... 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 (River Falls, WI)
- …Functional Screens (LTC-FS) for participants of the Wisconsin IRIS program - a Medicaid long-term care option for older adults and people with disabilities. The job ... + Completes contacts to verify screen results with IRIS Consultants, Medicaid Personal Care agencies, and verifies diagnosis information with physicians and… more
- CVS Health (Madison, WI)
- …and predetermination of covered benefits in the commercial, Medicare, and Medicaid environment. This Wheelchair DME consultant provides subject matter expertise in ... application of Aetna policies and practices for commercial, Medicare, and Medicaid environments. ◾Proactively use data analysis to identify opportunities for quality… more
- Humana (Madison, WI)
- …clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis and interpretation skills ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Humana (Madison, WI)
- …Principal coordinates, implements, and manages oversight of the company's Medicare/ Medicaid Stars Program for aligned areas. The Stars Improvement Principal ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Humana (Madison, WI)
- …flexibility in care manager's schedule. **Duties:** + Telephonically assess Medicare, Medicaid , and/or and Group Account members and create actionable and measurable ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more