- Molina Healthcare (Madison, WI)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Humana (Madison, WI)
- …determining objectives and approaches to assignments. This role is within the Medicare Finance organization. This role will be required to collaborate with various ... requests and perform valuations that help inform financial strategy related to the Medicare Advantage line of business. **Use your skills to make an impact**… more
- Humana (Madison, WI)
- …includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical… more
- Humana (Madison, WI)
- …best practices, and design clinical solutions for members who have Medicare and Medicaid. The Lead Product Manager partners across various multi-disciplinary ... our dual members - members that qualify for both Medicare and Medicaid. The Lead Product Manager sits in...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Madison, WI)
- …preferably in the health care or insurance industry, and specifically in Medicare Advantage products + Exceptional leadership and management skills, and the ability ... **Preferred Qualifications:** + Master's Degree + Knowledge of the Medicare Advantage market, products, regulations, and compliance standards **Additional… more
- Humana (Madison, WI)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission processes. Understands… more
- CVS Health (Madison, WI)
- …applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... International Classification of Disease (ICD) codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical… more
- Molina Healthcare (Kenosha, WI)
- …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
- Molina Healthcare (Green Bay, WI)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** + Master's in Business Administration, Public Health, Healthcare… more
- Elevance Health (Waukesha, WI)
- …end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare / Medicaid regulatory policies regarding FFS and zero-dollar claims. **How you ... background. + Requires experience using RADV protocols and following Center for Medicare and Medicaid Services (CMS) and Affordable Care Act (ACA) rules. **Preferred… more