- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …solutions that facilitate improvement. + Provide subject matter expertise of the CMS Star Rating methodology, and act as a resource when methodological questions ... decision makers. What We're Looking For + A deep understanding of the CMS Star rating methodology with experience working across all measurement domains including… more
- Fallon Health (Worcester, MA)
- …Appeals and Grievance process is an essential function to FH's compliance with CMS regulations, CMS 5 Stars, NCQA standards, other applicable regulatory ... necessary. + Assigning case files to the department staff for appeal/grievance management . + Providing administrative assistance in support of the Board of Hearings… more
- Sharp HealthCare (San Diego, CA)
- …Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA) **Hours** **:** **Shift Start Time:** Variable ... as established by SHC Corporate Compliance in accordance to the CMS and local MAC (Medicare Administrative Contractor) requirements. **Required Qualifications** +… more
- Atlantic Health System (Morristown, NJ)
- …enterprises. This role ensures enterprise-wide compliance with the Joint Commission, CMS , NCQA, and applicable state and federal regulations, while optimizing ... provider accountability, and operational excellence. Position Summary: + Provide system -level strategic leadership for all credentialing and privileging operations,… more
- Highmark Health (Pittsburgh, PA)
- …years' experience working in the health care/health insurance industry + Quality Management System certification Knowledge, Skills and Abilities + Experience in ... are compliant with regulatory guidelines/agencies, including but not limited to: NCQA, CMS , DPW, and DOH. Supports the integration of new vendors and lines… more
- Houston Methodist (Houston, TX)
- … CMS , and Medicaid to ensure proper department financial management , compliance with all governmental reporting requirements, and proper quality outcomes ... and transplant teams, and recipient candidate and family to ensure proper management of the organ recovery and transplant events. **PEOPLE ESSENTIAL FUNCTIONS** +… more
- Athena Health Care Systems (Marlborough, MA)
- …Medicare program agreement. + Issues and delivers Medicare denial letters per CMS regulations. + Assures appropriate management of residents' Medicare/Insurance ... notices timely and appropriately. + Complete and transmit all CMS approved item sets (MDS) + Must be knowledgeable...(MDS) + Must be knowledgeable of and follow current CMS regulatory guidelines as described in RAI Manual. +… more
- Dartmouth Health (Newport, NH)
- …* Performs the duties as Medical Director of the RHC as outlined in “ CMS Appendix G – Guidance for Surveyors: Rural Health Clinics (RHCs) Medical Director ... on quality initiatives. * Responsible for assuring compliance with CMS CAH and RHC conditions of participation and participating...patient concerns about care of patients at NHC. Business Management * Collaborates with the NHC leadership team to… more
- Baystate Health (Springfield, MA)
- …Dr. West Springfield, MA 01089 **Summary Description:** Coordinates Baystate Hospice to CMS , and Hospice Quality Management and Performance Improvement programs. ... quality management , performance improvement, and patient safety. Adhere to system and department compliance policies and any applicable laws and regulations.… more
- Staples (Framingham, MA)
- …landing pages, navigation structures, and interactive tools within the CMS . The Project Manager collaborates cross-functionally with merchandising, marketing, media ... site landing pages, navigation structures, and interactive tools within our CMS , aligning with merchandising and campaign objectives. + Draft visually compelling,… more