- Prime Therapeutics (Trenton, NJ)
- …help ensure efficient and effective solutions are implemented + Perform and review detail plans to address complex compliance issues by identifying goals, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Datavant (Trenton, NJ)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Atlantic Health System (Morristown, NJ)
- …- Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 - AARP + Gold-Level "Well ... highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its...100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -… more
- CVS Health (Trenton, NJ)
- …- Supports effective medical record capture for HEDIS(R) medical record review and abstraction of supplemental data - Public speaking **Required Qualifications** ... care experience in any setting - 1 years of Medicare experience and/or 1+ years of HEDIS medical record...- Recent and related experience working with HEDIS(R) - Medicare Stars experience or health insurance experience - Health… more
- Hackensack Meridian Health (Tinton Falls, NJ)
- …effectiveness and cost of patient care. Facilitate ongoing patient communications, review gaps in care and relevant outcome measures. HOMECARE SPECIFIC Responsible ... principles and processes. + Good working knowledge of benefit plans: HMO, Medicare , Medicaid, Employee, Commercial, Medicare Advantage, etc. + Experience with… more
- Otsuka America Pharmaceutical Inc. (Trenton, NJ)
- …territory plans through partnerships with internal and external stakeholders + Review and educate offices on payer policies, including prior authorization ... in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially... & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in "Buy and Bill"… more
- Humana (Trenton, NJ)
- …residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability to work effectively both ... + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : As part of our… more
- Nestle (Bridgewater, NJ)
- …grocery, drug, and/or mass retail channel(s) is required. + Knowledge of the Medicare Advantage business model preferred. + Experience in consumer goods and health & ... market share for the company and its customers. + Knowledge of the Medicare Advantage business model preferred. **SKILLS:** + Ability to manage multiple priorities… more
- Care Plus NJ (Paramus, NJ)
- …and reimbursement. The role requires strong knowledge of NJ Medicaid and Medicare billing, collaboration with clinical and executive teams, and problem-solving for ... and reimbursements from insurance companies and other third-party payers + Review , monitor, and evaluate third party reimbursement compliance and research variances… more
- Virtua Health (Cherry Hill, NJ)
- …adhere to standards as set forth by health system. Assist with review /change of policies and procedures to reflect current regulations and best practices. ... or ambulatory medical setting. Knowledge of insurance (ICD-9 CPT coding, Medicare regulations, state regulations, CLIA, DOH, and OSHA regulations) preferred. Solid… more