- Highmark Health (Pittsburgh, PA)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, working with… more
- UPMC (Williamsburg, PA)
- …Administration (HCFA) the American Osteopathic Association (AOA), and the Residency Review Committee (RRC). Performs day-to-day inpatient and outpatient billing and ... Notifies CCC of payments received at the office via computer reports. + Review payment listings from intermediaries and insurance companies for paid claims and also… more
- CVS Health (Harrisburg, PA)
- … review , diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition ... teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of...Classification of Disease (ICD) codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more
- Elevance Health (Harrisburg, PA)
- …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
- Prime Therapeutics (Harrisburg, PA)
- …related partner/customer relationships including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid. The Sr Director, Pharm ... + Direct the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as… more
- WellSpan Health (Lebanon, PA)
- …members of the health care team. Primary responsibilities include identification of Medicare patients appropriate for Annual Wellness Visits (AWV) and execution of ... knowledge, skills, and experience. **Duties and Responsibilities** **Essential Functions:** + Review office schedules and identify patients appropriate and due for … more
- Prime Therapeutics (Harrisburg, PA)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Evolent (Harrisburg, PA)
- …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
- Organon & Co. (Plymouth Meeting, PA)
- …state government pricing programs, including Medicaid Drug Rebate Program (MDRP), 340B, Medicare Part B/D, and the Veterans Affairs (VA)/Department of Defense (DOD) ... with GP AD & third-party government pricing vendor to implement, execute, review and approve price reporting. + Partner with third-party government pricing vendor… more
- Penn Medicine (Lancaster, PA)
- …to support changing patient care needs. Participates in the development and review of patient care standards, protocols and guidelines. + Monitors utilization of ... Functions as a patient advocate. + Participates in peer review activities identifying learning needs of practice related issues...+ A health care provider in good standing with Medicare , Medicaid and other federal and state health insurance… more