- CVS Health (Madison, WI)
- …to manage multiple health plan clients across multiple lines of business including Medicare , Medicaid, Exchange, and Commercial. This is a remote role, open to ... + Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics ( Medicare , Medicaid, Exchange, and or Commercial) and industry trends +… more
- Intermountain Health (Madison, WI)
- …with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services (CMS), National Center for Health Statistics (NCHS), US ... AND Demonstrated knowledge of government benefits and regulations related to Medicare , Medicaid or the ACA. AND Demonstrated knowledge of queries. **_Preferred… more
- Marshfield Clinic (Marshfield, WI)
- …Common Procedure Coding System (HCPCS), and Center for Medicaid and Medicare Services (CMS) documentation and billing policies. The individual will typically ... medical records, or medical business office setting. Knowledge of Medicare , Medicaid, and commercial payer guidelines. **Preferred/Optional:** Experience as a… more
- Molina Healthcare (Racine, WI)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Kenosha, WI)
- …Act** cases in accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Racine, WI)
- …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
- Humana (Madison, WI)
- …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 (Madison, WI)
- …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 (Madison, WI)
- …+ 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 (Madison, WI)
- …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