- Atlantic Health System (Morristown, NJ)
- …Duties & Responsibilities: * Maintain a thorough knowledge of the Medicare /Medicaid Hospice benefit including admission criteria, philosophy and services. * Educate, ... staff & Hospice CRC: * Duties assigned to Assistant Managers * POC review * Review Admission/Recert visits * Hospice Admission Coding * CTI completion * Work Que… more
- Prime Therapeutics (Trenton, NJ)
- …and expansion products within the vendor suite of solutions + Responsible to review dashboard and provide timely reporting of all required metrics; validate accuracy ... problem identification and resolution, process improvements, compliance with Centers for Medicare & Medicaid Services (CMS) regulations, client issues and quality… more
- Insight Global (Camden, NJ)
- …related claim edits and Revenue Guardian checks in various work ques, overseeing EPIC Charge Review Work Ques, and working with PB and HB Denial teams to review ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- Atlantic Health System (Morristown, NJ)
- …Line Manager. Establishes and maintains clinical communication and clinical review with CoCM collaborating psychiatrists. Age Specific Competencies: Child, Adult. ... and AMG Leadership. Implements and monitors programmatic adjustments determined through review of financial metrics in coordination with Service Line Manager and… more
- Mount Sinai Health System (NJ)
- …descriptions and the VMG Compact + Participate in the annual physician performance review process in Oncology Services + **Engage in the professional development of ... quality of care, medical group governance, quality assurance, risk management and peer review .** + Advocate on behalf of VMG Oncology Services providers with VMG and… more
- Prime Therapeutics (Trenton, NJ)
- …data analyses, and the Request For Proposal (RFP) process + Lead, manage, and review data analyses, reporting, and projections + Lead, manage, and review ad ... work experience in a healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 5 years of experience in SQL… more
- Atlantic Health System (Summit, NJ)
- …and evaluates direct reports and collaborate with senior management in the review , development, and monitoring of budgets. Provides track record in improving HCAHPS ... quality assurance programs and initiatives related to environmental services. + Review and analyze data on cleanliness performance, customer feedback, and infection… more
- Humana (Trenton, NJ)
- …looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes ... you have a solid background in medical auditing, coding** **,** **and medical record review ?** **If** **you answered** YES **to one or more of the above** **,**… more
- Humana (Trenton, NJ)
- …security architecture standards, and guiding engineering teams through the Technology Review Board and Architecture Review Board processes and participating ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Parsippany, NJ)
- …to state laws and regulations and market conduct findings reports. + Supports legal review , analysis, and outcomes of state mental health parity exams. + Legal ... review and assessment of any adverse state findings and...agencies. Healthcare laws and regulations including for example, ACA, Medicare , Medicaid, AWP/parity, pharmacy and/or mental health parity. Experience… more
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