- Molina Healthcare (Kenosha, WI)
- …or relationship ended * Work as liaison between Molina and/or National Medicare Broker/FMO, Exchange GA, sales agents and other departments (ie Membership ... with projects: o Competitive benefit comparison o Monthly activity submission review o Assist with provider presentations * Collaborate effectively with Community… more
- Marshfield Clinic (Marshfield, WI)
- …to both internal and external stakeholders as it relates to Medicare Advantage, ACA/Exchange and Medicaid risk adjustment reimbursement methodologies and policies ... of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of...for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to… more
- Marshfield Clinic (Eau Claire, WI)
- …are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._ **Minimum ... months of hire. + Certified Application Counselor designation through the Centers for Medicare and Medicaid Services within three months from the first fall training… more
- CVS Health (Madison, WI)
- …an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for… more
- Evolent (Madison, WI)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Walgreens (Wauwatosa, WI)
- …are correctly authorized and required documentation is on file. + Ensure all Medicare documentation is received from the medical provider and submitted to Danville. ... + Review reports to maximize generic substitution opportunities. + Manage...to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance… more
- Datavant (Madison, WI)
- …the application of learning to the work environment through various methods + Review client level audits and advise training content to re-educate team on coding ... and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of Medicare… more
- Prime Therapeutics (Madison, WI)
- …This role is dedicated to the government program compliance in the Medicare , Medicaid, and the Affordable Care Act (ACA) spaces. **Responsibilities** + Executes ... of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies + Research and… more
- Evolent (Madison, WI)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Madison, WI)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more