- Molina Healthcare (OH)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more
- Molina Healthcare (Cleveland, OH)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- OhioHealth (Columbus, OH)
- …or Finance. + Hospital and/or healthcare industry experience. + Understanding of the CMS prospective payment system and State of Ohio regulations. + Minimum ... **We are more than a health system . We are a belief system .**...This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.… more
- Humana (Columbus, OH)
- …practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials,… more
- Molina Healthcare (Akron, OH)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- Molina Healthcare (Columbus, OH)
- …average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services ( CMS ) regulations. + Ensures that adequate staffing ... for review. + Assures that activities and processes are compliant with CMS and National Committee of Quality Assurance (NCQA) guidelines and Molina policies… more
- Prime Therapeutics (Columbus, OH)
- …Medicaid Services ( CMS ) compliance compliant + Utilize Prime's MTM process management system to record member specific information + Assess beneficiary ... all lines of business to support the Centers for Medicare & Medicaid Services ( CMS ) Star and... system operations (eg workflow processes and case management ) + Government programs ( Medicare ) knowledge **Preferred… more
- Elevance Health (Mason, OH)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Humana (Columbus, OH)
- …community and help us put health first** The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation ... of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to… more
- Humana (Columbus, OH)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences,… more