- Molina Healthcare (Kenosha, WI)
- …DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is ... essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is… more
- Molina Healthcare (Kenosha, WI)
- …as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare /MMP. + Analysis and reporting related to Managed care data like Medical ... tracking for at least one line of business among Medicaid, Marketplace and Medicare /MMP. + 3+ Years of experience in working with increasingly complex data problems… more
- Molina Healthcare (Racine, WI)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Aveanna Healthcare (Waupaca, WI)
- …+ Valid CPR, Drivers License and Proof of automobile insurnace Preferred: + Medicare Skilled Nursing experience + Basic understanding of Oasis + 1-year RN experience ... in a health care setting As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant… more
- Humana (Madison, WI)
- …Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains ... 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 (Madison, WI)
- …financial integrity with sound pricing and risk management practices. The Medicare Actuarial Pricing team is responsible for anticipating and recognizing matters ... to the broader actuarial team. **A Brief Overview** Senior Analysts on the Medicare Actuarial team leverage strong technical skills to analyze data and pricing… more
- Aveanna Healthcare (Milwaukee, WI)
- …in the state of application + Valid CPR and Drivers License Preferred: + Medicare Skilled Nursing experience + Basic understanding of Oasis + 1-year LPN experience ... setting + Home Care Home Base exp a plus As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all… more
- Humana (Madison, WI)
- …reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CenterWell (Madison, WI)
- …in utilization management within Insurance industry a plus + Previous Medicare Advantage/ Medicare **Alert** Humana value's personal identity protection. Please ... be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ###@myworkday.com with instructions on how to add the information into your official application on Humana's… more
- Cognizant (Madison, WI)
- …based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/appeals ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more