- Elevance Health (Columbus, OH)
- …Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A reimbursement. ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...as assigned. + Prepare and perform supervisory review of cost report desk reviews and audits. +… more
- Elevance Health (Mason, OH)
- **Provider Contract/ Cost of Care Consultant** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, ... and adaptable workplace. Ideal candidates will be able to report to one of our Pulse Point locations in...accommodation is granted as required by law. The **Provider Contract/ Cost of Care Consultant** provides analytical support to the… more
- Humana (Columbus, OH)
- …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...are involved in Board and other administrative meetings. Fellows report directly to Joel Port, SVP, Business and Network… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **PMO ... and removal of barriers. Manage communication aspects of project status and track and report major issues. . Assists in managing all stages of the projects assigned… more
- Molina Healthcare (OH)
- …Plan and Finance team through analyzing key business issues related to cost , utilization and revenue for multiple Molina Healthcare products. Analyzes data and ... plan performance and identify the root causes of medical cost trends. With those root causes identified, drives improvement...achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB… more
- Molina Healthcare (Akron, OH)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... among hospitals, skilled nursing facilities and home care to ensure quality, cost -efficiency, and continuity of care. + Ensures that medical decisions are rendered… more
- OhioHealth (Columbus, OH)
- …ancillary departments. Analyze study budgets, including but not limited to cost analysis, calculating potential profit margins, etc. Effectively negotiates clinical ... expense tracking through study or grant closeout. Responsible for interaction with Medicare and applying Medicare regulations for device trials. Responsible for… more
- CenterWell (Columbus, OH)
- …evaluating and operationalizing high-impact complex care initiatives to drive quality and cost improvement for high-risk senior populations in full risk Medicare ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- ProMedica Health System (Toledo, OH)
- …the system, including those related to financial, quality, safety, experience, and cost -effective care delivery. The position will be a critical thought leader with ... targets; monitors and evaluates progress of these targets, including regular report outs in meetings, and in achieving overall efficiency and effectiveness… more
- OhioHealth (Columbus, OH)
- …Must have the ability to research complex issues pertaining to Medicare reimbursement and payment policies. This position assists in development, implementation, ... to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of the RAC case...and trend issues identified during the appeals process and report findings to Director. Actively participates in RAC program… more