- Molina Healthcare (OH)
- …for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare , and Marketplace lines of business. This includes direct management ... to support efficient and compliant subrogation operations across Medicaid, Medicare , and Marketplace populations. + Collaborate with legal, claims, provider… more
- CVS Health (Columbus, OH)
- …records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... record documentation review, diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical… more
- Elevance Health (Mason, OH)
- …equivalent background. + Requires experience using RADV protocols and following Center for Medicare and Medicaid Services ( CMS ) and Affordable Care Act (ACA) ... has experience working in leading healthcare payer claims/ revenue cycle management (RCM) organizations, with specific understanding in end-to-end claims/ encounter… more
- Fresenius Medical Center (Youngstown, OH)
- …material assist devices for the heavier items. **EDUCATION** + Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification or High ... testing including Pressure Holding (PHT). + Initiate Solution Delivery System (SDS) system . + Ensure that all...+ Inventory for Patients + Assists patient with supply management and contacting customer service **PHYSICAL DEMANDS AND WORKING… more
- Fresenius Medical Center (Cortland, OH)
- …**LICENSES:** + HighSchooldiplomaorG.E.D. required. + Must meet Center for Medicaid/ Medicare Services ( CMS )-approved state and/or national certification ... machine alarm testing including Pressure Holding (PHT). + Initiate Solution Delivery System (SDS) system . **RECORD KEEPING:** + Complete and document ongoing… more
- ABM Industries (Middleburg Heights, OH)
- …restraints, while meeting standards outlined by The Joint Commission (TJC), Centers for Medicare & Medicaid Services ( CMS ), ABM Healthcare Support Services and ... visit ABM Employee Benefits | Front Line Team Members (https://wpe-media.abm.com/wp- content /uploads/2025/ABM\_2025\_Employee\_Benefits\_Frontline\_v2\_English\_9.5.24.pdf) | (Programa de Beneficios de ABM) **Basic Qualifications:**… more
- Molina Healthcare (OH)
- …and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ... Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing… more
- Humana (Columbus, OH)
- …data driven methods to develop and influence formulary strategies for Humana's Medicare line of business. + Utilizes broad understanding of pharmacy, managed care, ... pharmacy related field + Experience in Formulary strategy/development and CMS Part D guidance + Experience in analysis and...with staff in different positions and all levels of management positions. + Ability to prioritize, organizes, and executes… more
- Molina Healthcare (Akron, OH)
- …Action Items (SAIs) including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay edits, post payment ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
- Humana (Columbus, OH)
- …by reading and interpreting claims + Exceptional understanding of Centers for Medicare & Medicaid Services ( CMS ) guidelines, state Medicaid guidelines, correct ... first** The Senior Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing… more