- WelbeHealth (Madison, WI)
- …technical analysis, operations, and internal controls + Oversee the preparation and review process for financial and operational reports required by our core ... + Assist with month-end close, quarterly financial reporting, financial audit, Medicare /Medicaid audits, and other PACE specific projects + Keep a… more
- Elevance Health (Waukesha, WI)
- …actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an Impact** Primary duties ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven analyses… more
- Humana (Ashland, WI)
- …face-to-face visits and monthly phone contacts. + Participate in the development and ongoing review and coordination of the member's plan of care. + Take the lead in ... continuously improving consumer experiences **Preferred Qualifications** **Prior experience with Medicare & Medicaid recipients** + Previous experience with electronic… more
- Molina Healthcare (Green Bay, WI)
- …Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing ... in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model… more
- St Croix Hospice (Eau Claire, WI)
- …Communication + Communicates and collaborates with the interdisciplinary group to create, review and revise the patient's plan of care. + Consults with the ... Additional Duties + Maintains knowledge of and compliance with current Medicare /Medicaid, state/federal rules and regulations for hospice services + Ensures… more
- Molina Healthcare (Janesville, WI)
- …products to coordinate a medical plan of care and capture diagnoses for Medicare risk adjustment. The NP/PA will utilize advanced assessment skills to diagnose and ... present at the time of the visit. Obtain vital signs, measure BMI, review pharmacological therapy and conduct a physical examination. + Capture and document annual… more
- Banner Health (WI)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... accurate coding based on documentation for positive outcomes. 5. Performs ongoing audits/ review of inpatient and/or outpatient medical records to assure the use of… more
- Centene Corporation (Madison, WI)
- …healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and families served by the ... cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and… 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 ... are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._ **Minimum… more
- Marshfield Clinic (Horicon, WI)
- …the department 4. Assists in policy and procedure development and review 5. May participate in interviews **JOB QUALIFICATIONS** **EDUCATION/EXPERIENCE** **Minimum ... are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._ **Minimum… more