- Humana (Madison, WI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... 2+ years of actuarial experience in healthcare + SAS or other coding skills + Medicare experience + Familiarity with CMS Star Ratings Travel: While this is a remote… more
- St Croix Hospice (Delavan, WI)
- …growth. Additional Duties + Maintains knowledge of and compliance with current Medicare / Medicaid , state/federal rules and regulations for hospice services + ... Ensures compliance with the Medicare conditions of participation and other state regulations govern the provision of healthcare. + Complies with all Health Insurance… more
- Humana (Madison, WI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... + **Industry Knowledge** : Familiarity with the healthcare sector, specifically Medicare Advantage, and an understanding of regulatory frameworks and market… more
- Evolent (Madison, WI)
- …under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person" by ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or legal action by a state… more
- Evolent (Madison, WI)
- …under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person" by ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or legal action by a state… more
- United Therapeutics (WI)
- …Teams + Advanced knowledge of medical insurance terminology + Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in ... Medicare (Part B and Part D) Job Location This position will require candidates to live within the assigned territory. This includes North Dakota, South Dakota,… more
- Gentiva (Madison, WI)
- …and external providers + Ensure adherence to hospice industry regulations including Medicare , Medicaid , JCAHO, ACHC **About You** **Qualifications - What You'll ... Manage clinical and administrative workflows, including referrals, DME pickups, Medicare eligibility, insurance verification, and patient benefit tracking +… more
- Molina Healthcare (Kenosha, WI)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials ... Qualifications** * Customer/provider experience in a managed care organization ( Medicaid , Medicare , Marketplace and/or other government-sponsored program), or… more
- CVS Health (Madison, WI)
- …process, pre-certification, and predetermination of covered benefits in the commercial, Medicare , and Medicaid environment. This Wheelchair DME consultant ... alignment and correct application of Aetna policies and practices for commercial, Medicare , and Medicaid environments. ◾Proactively use data analysis to identify… more
- Molina Healthcare (Green Bay, WI)
- …Common Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other ... medically appropriate clinical guidelines, Medicaid , Medicare , CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access… more