• Sr Compliance RCM & Coding Auditor

    Humana (Madison, WI)
    …revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of healthcare records + ... 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 (08/23/25)
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  • AVP, Duals Market Enablement (Remote)

    Molina Healthcare (Madison, WI)
    …or equivalent combination of relevant education and experience + Medicare and/or Medicaid Managed Care experience + Quantitative aptitude + Strong leadership in a ... experts, and external resources. **PREFERRED QUALIFICATIONS:** + Integrated products ( Medicaid -Medicare) experience + Experience in regulatory regulations and monitoring… more
    Molina Healthcare (08/22/25)
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  • AVP, Encounters

    Molina Healthcare (Kenosha, WI)
    …evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This role has decision-making accountability for ensuring ... or above. + Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including encounter data submission and deletion requirements… more
    Molina Healthcare (08/22/25)
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  • Case Manager

    Humana (Rice Lake, WI)
    …consumer experiences **Preferred Qualifications** **Prior experience with Medicare & Medicaid recipients** + Previous experience with electronic case note ... 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 (08/21/25)
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  • Medical Billing Specialist

    Robert Half Accountemps (Milwaukee, WI)
    …compliance with insurance and government regulations, including Medicare and Medicaid requirements. * Communicate effectively with clinical and administrative staff ... of insurance regulations and compliance requirements, including Medicare and Medicaid . * Effective communication and organizational skills to coordinate with… more
    Robert Half Accountemps (08/19/25)
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  • Encounter Data Management Professional

    Humana (Madison, WI)
    …or adjacent sectors **Preferred Qualifications** + Comprehensive knowledge of Medicare, Medicaid , and DSNP encounter processes and policies. + Working knowledge of ... 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 (08/16/25)
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  • SNF Utilization Management RN - Compact Rqd

    Humana (Madison, WI)
    …or Bachelor's degree in a related field + Health Plan experience + Previous Medicare/ Medicaid Experience a plus + Call center or triage experience + Bilingual is a ... 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 (08/09/25)
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  • Senior Specialist, Member & Community…

    Molina Healthcare (WI)
    …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting, analysis, and/or interpretation +… more
    Molina Healthcare (07/31/25)
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  • Delaware Valley ACO Fellowship

    Humana (Madison, WI)
    …accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and ... 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 (07/30/25)
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  • Regulatory Specialist Senior

    SSM Health (Fond Du Lac, WI)
    …knowledge of all The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) Conditions of Participation and State Hospital Licensing Act standards ... readiness related to The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS) Conditions of Participations (CoPs) and State specific regulations.… more
    SSM Health (07/29/25)
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