- CVS Health (Madison, WI)
- …day. Aetna's Revenue Integrity team is hiring Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a critical part in ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...and internal policies and procedures. + Proven ability to support coding judgment and decisions using industry standard evidence… more
- Humana (Madison, WI)
- …Plan and the identified Prepaid Inpatient Health Plans (PIHPs). This position will support day-to-day operations as a subject matter expert for the Humana market ... PIHPs. + Ensures compliance with accreditation standards, contract, and Center for Medicare and Medicaid Services (CMS) requirements. + Works closely with the… more
- Humana (Madison, WI)
- …standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring compliance with governmental ... experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of… more
- Humana (Beloit, WI)
- …us put health first** Humana Gold Plus Integrated is seeking Long-Term Services and Support (LTSS) Care Coordinators (Care Coach 1) in Illinois Region 2 to assess ... management. + One (1) or more years of experience working with Medicare and Medicaid recipients, long-term care services, Home and Community-Based Services (HCBS),… more
- Humana (Madison, WI)
- …maintaining optimum health. We provide telephonic outreach to assess and support their health, offering education, identifying resources, and helping remove barriers ... to day flexibility in care manager's schedule. **Duties:** + Telephonically assess Medicare , Medicaid, and/or and Group Account members and create actionable and… more
- Gentiva (Milwaukee, WI)
- …operations, ensuring compliance with state, federal, and accreditation standards (CMS, Medicare , Joint Commission, etc.) + Provide clinical oversight and ensure ... documentation of hospice services + Interview, hire, supervise, evaluate, and support interdisciplinary hospice staff including RN Clinical Managers, RNs, LPNs,… more
- Humana (Madison, WI)
- …Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or ... or Bachelor's degree in a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage experience + Bilingual is a… more
- Marshfield Clinic (Marshfield, WI)
- **Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!** **Job Title:** Hospital Coding Specialist ... III (Remote) **Cost Center:** 101651098 System Support -Facility Coding **Scheduled Weekly Hours:** 40 **Employee Type:** Regular **Work Shift:** Mon-Fri; day shifts… more
- Evolent (Madison, WI)
- …with leadership, management, and clinical staff to address complex cases and support decision-making. + Act as a key resource for Initial Clinical Reviewers, ... to the Utilization Management process, interpretation, guidelines and/or system support . + On a requested basis, may function as...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- SSM Health (Fond Du Lac, WI)
- …a working knowledge of all The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) Conditions of Participation and State Hospital Licensing ... of continual readiness related to The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS) Conditions of Participations (CoPs) and State specific… more