- 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 ... federal health programs. The **Audit and Reimbursement II** will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for … more
- Humana (Madison, WI)
- …in navigating multiple computer tools/systems/screens + 2+ years of Medicare customer service experience or sales experience (virtual/telephonic preferred) + ... Demonstrated ability to understand and explain Medicare benefits and address the unique needs of ...protection. Please be aware that applicants selected for leader review may be asked to provide their social security… more
- Intermountain Health (Madison, WI)
- …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
- CVS Health (Madison, WI)
- …**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
- Walworth County (Elkhorn, WI)
- …of activities in order to create claims for insurance, Medicaid, Medicare and consumer self-pay statements. SCHEDULE Division: Administration Days: Monday - ... Health Record (EHR) daily to assure that medical billing records are accurate. Review appropriate client and/or billing reports to find and fix errors to ensure… more
- Prime Therapeutics (Madison, WI)
- …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 (Madison, WI)
- …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
- Prime Therapeutics (Madison, WI)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Molina Healthcare (Milwaukee, WI)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… 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 ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more