- Geisinger (Danville, PA)
- …Performs coverage analysis for clinical studies, including billing determination review and Medicare coverage analyses to ensure regulatory compliance . + Creates ... processes. + Maintains active partnerships with the Office of Research Compliance , IRB Operations, Research Finance, Insurance Risk Services Corporate Office,… more
- Highmark Health (Camp Hill, PA)
- …budgetary responsibility and authority. + As a seasoned Group Retiree market expert ( Medicare Advantage, Medicare Supplement, Part D, Medicare Exchanges) ... Continuously monitor and maintain knowledge of the Commercial, Group Retiree and Medicare markets and competition. + Develop strategies and tactics to optimize… more
- Wolters Kluwer (Philadelphia, PA)
- …information and policy data sources (CMS, FDA, etc.) covering drug control/ compliance programs, covered programs ( Medicare /Medicaid) and other government ... drug-related policy and program information. * Have an in-depth understanding of drug classification systems, drug packaging attributes, drug clinical attributes, pricing and reimbursement data, and regulatory classifications-and how these data types are used… more
- Humana (Harrisburg, PA)
- …the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. **Required Qualifications** + MD or DO degree + 5+… more
- Humana (Harrisburg, PA)
- …the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance ... a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Harrisburg, PA)
- …our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates ... Medicare Advantage and Prescription Drug Plans using approximately 40...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Heritage Ministries (Conneautville, PA)
- …pre-admission notes and face sheet, and the primary insurance coverage (other than Medicare ). Verifies the Medicare benefit and coverage as well as benefits ... insurances. (Admissions will obtain pre-authorization for primary insurances other than Medicare ). Obtains copies of the resident's insurance cards, POA or… more
- Humana (Harrisburg, PA)
- …segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement Professional, you ... initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, leading the development of the...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- WellSpan Health (York, PA)
- …entries using the Crowe RCA tool. Assists in preparation and filing of Medicare and Medicaid cost reports, therefore, must stay abreast of current governmental ... for net revenue projections. + Assists in coordination, preparation, and submission of Medicare and Medicaid cost reports using data from company general ledger and… more
- Redeemer Health Home Care & Hospice (Huntingdon Valley, PA)
- …coding (https://www.aapc.com/certification/medical-coding-certification.aspx) guidelines and regulations including compliance and reimbursement - allowing a CRC ... clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and Medicaid regulations and billing guidelines and AMA's publication CPT… more