- Humana (Madison, WI)
- …expert on the End Stage Renal Disease (ESRD) population for Humana's individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims ... technical skills, especially SQL, VBA, and Databricks/Python + Individual Medicare Advantage experience + Knowledgeable on ESRD population **Additional Information**… more
- Humana (Madison, WI)
- …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
- Molina Healthcare (Milwaukee, WI)
- …accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Manages team ... complicated claims, COB and DRG/RCC pricing). * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Humana (Madison, WI)
- …Experience working in coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills developing reports and ... role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Marshfield Clinic (Wisconsin Rapids, WI)
- …months of hire. + Certified Application Counselor designation through the Centers for Medicare and Medicaid Services within three months from the first fall training ... time of hire. + Certified Application Counselor designation through the Centers for Medicare and Medicaid Services at time of hire. **Marshfield Clinic Health System… more
- Prime Therapeutics (Madison, WI)
- …in a manner that meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Humana (Madison, WI)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical ... management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with… 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
- Deloitte (Milwaukee, WI)
- …knowledge of the individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or Medicare Supplement products ... for various enrollee types + Experience with reimbursement models - including value based care/ACO modeling + Knowledge of group insurance products including disability, long term care, etc. The wage range for this role takes into account the wide range of… more
- Prime Therapeutics (Madison, WI)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more