- Molina Healthcare (Tampa, FL)
- …according to the SIU's standards. Position must have thorough knowledge of Medicaid/ Medicare /Marketplace health coverage audit policies and be able to apply them in ... data from all types of healthcare providers that bill Medicaid/ Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure investigators are managing their cases… more
- HCA Healthcare (Tamarac, FL)
- …you will need:** + Two years of experience within a licensed and certified ( Medicare ) home health agency required + Competent in Federal ( Medicare ) and Local ... to providing patients with quality care during their recovery at home. We are Medicare certified. Our patients are under the supervision of a physician and our team… more
- CenterWell (Fort Lauderdale, FL)
- …Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum of two to five ... years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best...in a value based relationship environment . Knowledge of Medicare guidelines and coverage . Bilingual is a plus… more
- Molina Healthcare (Miami, FL)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- Humana (Tallahassee, FL)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Tallahassee, FL)
- …of the responsibilities: + Engage with the producers and the Center for Medicare and Medicaid Services/Department of Insurance regulations specific to them if there ... proper entries to the general ledger. + Analyze and interpret Center for Medicare and Medicaid Services and Department of Insurance regulations to establish required… more
- Humana (Tallahassee, FL)
- …+ 3+ years of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA highly preferred. + ... role is part of a team that owns the Medicare Advantage pricing methodology and supporting tools in the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Tallahassee, FL)
- …This role will support a few tools used within our Individual Medicare Advantage pricing and internal reporting process. This includes: + Helping make ... Qualifications** + Strong technical skills, especially SQL and VBA + Individual Medicare Advantage experience Travel: While this is a remote position, occasional… more
- Humana (Tallahassee, FL)
- …Principal coordinates, implements, and manages oversight of the company's Medicare /Medicaid Stars Program for aligned areas. The Stars Improvement Principal ... etc. + 5 years or more of CMS Stars program experience + Medicare Advantage experience + Previous leadership experience as a people leader, leading through… more
- Humana (Tallahassee, FL)
- …the development, implementation and management oversight of the company's Medicare /Medicaid Stars Program. The Senior Stars Improvement, Clinical Professional work ... of prior HEDIS, STARS and/or quality improvement experience in Medicaid or Medicare (Medicaid quality improvement a plus). + Proficient/ intermediate utilization of… more