- Molina Healthcare (Racine, WI)
- …QUALIFICATIONS:** + At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, ... tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met...including experience in Medicaid and/or Medicare, or equivalent combination of relevant education… more
- WestCare Foundation (Milwaukee, WI)
- …+ Maintain proper balance regarding source of payment (fee for service, Medicaid , public, private, and third-party payers) + Responsible for educating clients on ... with coverage and escalates complicated issues to the billing manager and/or director. + Coordinate with the billing ...basis. + Assist all clients with application process for Medicaid by assisting with completion of the application, addressing… more
- Marshfield Clinic (Marshfield, WI)
- …any time have been or be excluded from participation in any federally funded program , including Medicare and Medicaid . This is a condition of employment. ... for Sanford Health Plan's Medicare, Affordable Care Act and Medicaid business and reports to the Senior Director, Chief...Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she… more
- Marshfield Clinic (Weston, WI)
- …any time have been or be excluded from participation in any federally funded program , including Medicare and Medicaid . This is a condition of employment. ... individual reviews financial assistance and medication assistance applications to ensure program and financial requirements are met. The individual may calculate… more
- Humana (Ashland, WI)
- …community and help us put health first** Humana is seeking a Social Worker/Case Manager , aka: Community Resource Coordinator (CRC), to join the Inclusa team to serve ... members in the Wisconsin Family Care (FC) program . In this role, you will be responsible for partnering with your fellow colleagues to provide top quality care to… more
- Molina Healthcare (WI)
- …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... and programs in accordance with prescribed program standards, conducts data collection, monitors intervention activity including...to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may… 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** ... with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health...independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings… more
- SSM Health (Fond Du Lac, WI)
- …implementation of an integrated regulatory compliance and accreditation program . **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Possesses ... all The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) Conditions of Participation and State Hospital...to address those risks, and monitors to ensure the program is following best practices and standards. + Serves… 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
- Marshfield Clinic (Beaver Dam, WI)
- …any time have been or be excluded from participation in any federally funded program , including Medicare and Medicaid . This is a condition of employment. ... resident needs and maintain appropriate weight, report any changes to CNA, Lead, Manager , or Director. 6. Involves residents in cooking based and purposeful activity… more