- Cardinal Health (Madison, WI)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Prime Therapeutics (Madison, WI)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... experience + Knowledge of the applicable line of business (eg, Medicare , Medicaid, Exchange, Commercial, Employer Group) Every employee must understand, comply… more
- Robert Half Accountemps (Milwaukee, WI)
- …and committed to maintaining accurate and timely reimbursement practices. Responsibilities: * Review and update patient accounts to ensure billing data is accurate ... * Ensure compliance with insurance policies and government regulations, including Medicare and Medicaid requirements. * Communicate with clinical and administrative… more
- Humana (Madison, WI)
- …residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability to work effectively both ... + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : As part of our… more
- CVS Health (Madison, WI)
- …to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... of 1 year recent and related experience in medical record documentation review , diagnosis coding, and/or auditing. + Completion of AAPC/AHIMA training program for… more
- CenterWell (Madison, WI)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare + Current nursing experience in Hospital, SNF,… more
- Humana (Madison, WI)
- …Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes + Proficient ... is higher. **Preferred Qualifications** + Bachelor's Degree + Previous experience in Medicare Advantage or Value-Based Care + AAPC CRC (Certified Risk Adjustment)… more
- CenterWell (Madison, WI)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- Marshfield Clinic (Marshfield, WI)
- …Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG ( Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related ... required for this position. L_ _icenses_ _with restrictions are subject to review to determine if restrictions are substantially related to the position_ **Minimum… more
- Prime Therapeutics (Madison, WI)
- …strategic plans that achieve Star Ratings and quality outcomes for Medicare , Medicaid, Individual Health Insurance Marketplace, and Commercial lines of business. ... the client quality support model strategy for all lines of business ( Medicare , Medicaid, commercial/HIM); serve as primary enterprise point of contact and subject… more