- UPMC (Pittsburgh, PA)
- …corporate and commercial healthcare transactions, including due diligence, contract drafting, review and negotiation. Provide guidance with respect to these and ... health care and general corporate legal matters in areas such as Medicare , Medicaid, licensure, malpractice liability, , compliance (eg, Anti-Kickback Statute, False… more
- Prime Therapeutics (Harrisburg, PA)
- …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
- University of Pennsylvania (Philadelphia, PA)
- …portfolio. Manage post award activities including account set up, monitor and review of all sponsored projects expenditures including fund projections. Monitor and ... portfolio. Manage post award activities including account set up, monitor and review of all sponsored projects expenditures including fund projections. Monitor and… more
- CSL Behring (King Of Prussia, PA)
- …reimbursement education and training and manages relationships with regional Medicare offices and Carrier Advisory Committees. **Main Responsibilities and ... marketing and sales objectives. + Work directly with third party payers and Medicare offices to insure adequate reimbursement for our products. + Provide monthly… more
- Datavant (Harrisburg, PA)
- …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
- St. Luke's University Health Network (Hamburg, PA)
- …Access leadership or Revenue Cycle Operational Improvement Team (monthly competencies/policy review ). + Responsible for sign in registry for vendors and clergy, ... + Responsible for completing government forms including Important Message from Medicare , and Medicare Outpatient Observation Notice signature processes on… more
- Otsuka America Pharmaceutical Inc. (Harrisburg, PA)
- …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
- Penn Medicine (Lancaster, PA)
- …insurance information into the clinical pharmacy information system for pharmacist review . + Communicates with insurance carriers to obtain payment for prescription ... + A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance...health insurance programs, ie, not excluded from participation in Medicare , Medicaid or any other federal or state health… more
- BAYADA Home Health Care (Norristown, PA)
- …and families at designated facilities to coordinate the initiation of home health care ( Medicare ) services. This will be a hybrid role. The TCM will work from home, ... Demonstrate mastery of clinical and regulatory home care eligibility criteria. + Review all medical documentation and work with physicians to make clinical judgments… more
- Prime Therapeutics (Harrisburg, PA)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... experience + Knowledge of the applicable line of business (eg, Medicare , Medicaid, Exchange, Commercial, Employer Group) Every employee must understand, comply… more