- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Intermountain Health (Trenton, NJ)
- …cycle (Payment Posting, Billing, Follow-Up) required + Knowledge of Medicaid and Medicare billing regulations required + Two (2) years of experience in hospital ... or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections) preferred **Physical Requirements** + Operate computers and other office equipment requiring the ability to move fingers and hands. + Remain sitting or… more
- Humana (Trenton, NJ)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization. **Additional… more
- Intermountain Health (Trenton, NJ)
- …HIM, PAS, and hospital finance staff as needed. + Prepares monthly Medicare and Medicaid settlement and policy reserve calculations using technically acceptable and ... and exception requests to appropriately maximize reimbursement. Interacts with Medicare Administrative Contractor, State Medicaid, and hospital personnel as needed.… more
- Merck (Rahway, NJ)
- …including our Company's Annual Enrollment, Retiree Health Exchange and the Medicare Open Enrollment, compliance, call center excellence and benefit communications. ... programs at critical moments in their career lifecycle (ie retirement, separation) + Review , research and respond to employee and retiree issues to ensure a seamless… more
- CVS Health (Trenton, NJ)
- …**Key Responsibilities** : + Drafting and reviewing product filings: Draft Medicare Supplement and short-term limited duration health insurance products (policies, ... Stay abreast of changes in state and federal regulations related to Medicare supplement insurance. + Record Keeping: Maintain accurate records of product filings… more
- Prime Therapeutics (Trenton, NJ)
- …is responsible for receiving inbound and making outbound calls to qualified members to review the benefits of the MTM programs in addition to assisting the leaders ... in a manner that meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliant + Act… more
- Prime Therapeutics (Trenton, NJ)
- …strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality ... goals + Drive the client quality strategy for all lines of business ( Medicare , Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert… more