- Molina Healthcare (Racine, WI)
- …unrestricted State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review , medical policy/procedure development, ... quality and financial goals across all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the BH MD lead trainers in the… more
- Humana (Madison, WI)
- …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 (Madison, WI)
- …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 (Madison, WI)
- …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 (Madison, WI)
- …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
- Molina Healthcare (Green Bay, WI)
- …Company's assigned contact to log tickets for premium restoration such as Medicare Secondary Payer and ESRD. **JOB QUALIFICATIONS** **Required Education** HS Diploma ... or GED **Required Experience** 1-3 years' experience in an administrative support. **Preferred Education** Associate degree **Preferred Experience** 3+ years' experience in an administrative support role. To all current Molina employees: If you are interested… more
- Elevance Health (Waukesha, WI)
- …+ Assist in mentoring less experienced associates as assigned. + Perform supervisory review of workload involving complex areas of Medicare part A reimbursement ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...all cost based principles. + Prepare and perform supervisory review of cost report reopenings. + Manage caseload of… more
- Molina Healthcare (Racine, WI)
- …and production of the annual marketing strategy and objectives for Molina Medicare 's portfolio of Medicare products. + Responsible for supporting the ... + Developing, implementing, improving, and maintaining Marketing Operations for Molina Medicare . + Directing and analyzing Market Research Activities for Molina … more
- Elevance Health (Waukesha, WI)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... programs. The **Audit and Reimbursement III** will support our Medicare Administrative Contract (MAC) with the federal government (The...directed by management. + Participates in special projects and review of work done by auditors as assigned. +… more
- Molina Healthcare (Green Bay, WI)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more