- Molina Healthcare (WI)
- …+ Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
- Cognizant (Madison, WI)
- **Provider Appeals & Grievances Specialist ** (remote) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** We are ... seeking a dedicated Provider Appeals & Grievance Specialist with 1 to 2 years of experience to...the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible… more
- Marshfield Clinic (Marshfield, WI)
- …exciting missions in the world!** **Job Title:** Clinical Pharmacy Specialist **Cost Center:** 301641296 Pharmacy-Admin **Scheduled Weekly Hours:** 40 **Employee ... (United States of America) **Job Description:** **JOB SUMMARY** The Clinical Pharmacy Specialist works with physicians, staff, and committees to optimize the care of… more
- Prime Therapeutics (Madison, WI)
- …every decision we make. **Job Posting Title** Medication Therapy Management Specialist **Job Description** The Medication Therapy Management (MTM) Service ... Specialist is responsible for receiving inbound and making outbound...targeted population; for Medicare, is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM… more
- SSM Health (Fond Du Lac, WI)
- …Highlights:** **We're Hiring!** SSM Health is seeking a **Medical Equipment and Supply Specialist ** to join our **Continuum of Care** team at the **Agnesian Health ... and development Location: Agnesian Health Shoppe, WI Apply here: https://ssmh.wd5.myworkdayjobs.com/ssmhealth/job/WI-Agnesian-Health-Shoppe/Medical-Equipment-and-Supply- Specialist --Continuum-of-Care\_R178388-1 Tag someone who'd be a great fit or… more
- Molina Healthcare (Green Bay, WI)
- …sales and marketing of Molina Medicare products to dual eligible, Medicare- Medicaid recipients within approved market areas to achieve stated revenue, profitability, ... the product choices available to them, the enrollment process ( eligibility requirements, Medicare review/approval of their enrollment application, timing of… more
- Cognizant (Madison, WI)
- …on the review of clinical documentation in accordance with Medicare, Medicaid , and third-party guidelines. . Effectively document and log claims/appeals information ... offers the following benefits for this position, subject to applicable eligibility requirements: * Medical/Dental/Vision/Life Insurance * Paid holidays plus Paid… more
- SSM Health (Madison, WI)
- …provide medical equipment and supplies. + Verifies patient insurance eligibility /benefits and communicates financial responsibilities to patients, caregivers, and ... and prior authorization for appropriate equipment/supplies. + Ensures compliance with Medicare, Medicaid and Accreditation Standards. + Works in a constant state of… more
- Humana (Beloit, WI)
- …payer sources, providers, and interdisciplinary care teams. + Educates members in maintaining Medicaid eligibility . + Assist with entry of annual Level of Care ... help us put health first** The Care Coach 2 (Transition/Custodial Prevention Specialist ) assesses and evaluates member needs and requirements to achieve and/or… more
- St Croix Hospice (Eau Claire, WI)
- …patients, completes physical and face-to-face assessments, and evaluates hospice eligibility as assigned in consultation with the hospice interdisciplinary team. ... required face-to-face assessments for hospice recertification and provides clinical eligibility information to the medical director. + Ensures effective symptom… more