- Humana (Harrisburg, PA)
- …reviewing criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred **Additional Information** ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Kestra Medical Technologies, Inc (Allentown, PA)
- …products regulated by the Federal Food and Drug Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing is a condition of ... products regulated by the Federal Food and Drug Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing is a condition of… more
- Sedgwick (Harrisburg, PA)
- …limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests ... principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral… more
- Penn Medicine (Lancaster, PA)
- …30 days of hire. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie not excluded from ... participation in Medicare , Medicaid or any other federal or state health insurance program. + As outline in unit based Plan for Provision of Care. We believe that… more
- UPMC (Pittsburgh, PA)
- …clinical management of the designated line of business (Commercial, Exchange, Medicare , Medicaid, Exchange, and/or CHIP) from a pharmacy formulary and operational ... managed care experience in formulary development and management, especially in Medicare , Medicaid, Commercial and/or Exchange lines of business. + Effective… more
- Penn Medicine (Lancaster, PA)
- …30 days of hire. + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie not excluded from ... participation in Medicare , Medicaid or any other federal or state health insurance program. + As outline in unit based Plan for Provision of Care + Attention… more
- Humana (Harrisburg, PA)
- …existing environment while minimizing disruption and mitigating risks + Experience with Medicare and/or Medicaid + Ability to coordinate with development and user ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Robert Half Finance & Accounting (Carlisle, PA)
- …efficiency. Responsibilities: * Oversee the revenue cycle processes for Medicaid, Medicare , managed care, commercial payers, and sliding fee programs. * Establish ... payer compliance, and revenue cycle systems. * Knowledge of Medicaid, Medicare , and commercial payer processes. * Excellent leadership and communication skills… more
- Humana (Harrisburg, PA)
- …and oversee execution of, numerous strategies required to ensure success for our Medicare Stars and Medicaid LOBs. The ideal candidate for this role will thrive ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Harrisburg, PA)
- …CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... record documentation review, diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical… more