- CVS Health (Madison, WI)
- …CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... to appropriate departments and management. + Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations. +… more
- Humana (Madison, WI)
- …have comprehensive knowledge of processes, policies and procedures as well as compliance guidelines. Will support achieving operational and compliance key ... or adjacent sectors **Preferred Qualifications** + Comprehensive knowledge of Medicare , Medicaid, and DSNP encounter processes and policies. + Familiarity… more
- Humana (Madison, WI)
- …time with demonstrated advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The nature of the work ... concurrently navigating multiple computer applications. Due to the auto dialer process and compliance needs of the business there is limited day to day flexibility… more
- Gentiva (Madison, WI)
- …by managing patient care activities, supervising clinical staff, and ensuring compliance with all company policies and regulatory standards. Great opportunity to ... + Lead and support hospice patient care operations to ensure quality and compliance + Supervise, teach, evaluate, and develop nursing and clinical associates +… more
- Molina Healthcare (Kenosha, WI)
- …oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This role has ... decision-making accountability for ensuring compliance with complex regulatory requirements, protecting the integrity of enterprise revenue, and enabling the… more
- Banner Health (WI)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Provides feedback on coding work and trends, and offers… more
- Molina Healthcare (Milwaukee, WI)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, ... and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and… more
- Humana (Madison, WI)
- …Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Understands ... **Preferred Qualifications** + Experience with SQL or VBA + Medicare experience Travel: While this is a remote position,...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Madison, WI)
- …with members while concurrently navigating multiple computer applications. To ensure compliance and support the auto dialer process essential to our business, ... communication and interpersonal skills. **Duties Include** + Telephonically work with Medicare members with transitional needs and complex chronic conditions. +… more
- Aveanna Healthcare (Milwaukee, WI)
- …and Milwaukee areas Essential Job Functions + Deliver quality patient care in compliance with physician orders under direction of their Registered Nurse teammate. * ... application + Valid CPR and Drivers License Preferred: + Medicare Skilled Nursing experience + Basic understanding of Oasis...Home Base exp a plus As an employer accepting Medicare and Medicaid funds, employees must comply with all… more