- CVS Health (Dover, DE)
- …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 ... setting. + Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity. + Identify clinically active… more
- Molina Healthcare (Meridian, ID)
- …improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers ... for Medicare and Medicaid Services (CMS), state Medicaid entity requirements...cost-effective member care. This position will support our Corporate Compliance business. The candidate must have an unrestricted LVN… more
- Fallon Health (Lowell, MA)
- …product regulatory requirements and Program policies and processes o Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
- Elevance Health (Lake Mary, FL)
- …and provider information. + Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies ... re-credentialing of applications. + Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials. + Maintains all pharmacy site… more
- Albany Medical Center (Albany, NY)
- …the Laboratory Billing Procedures Manual, working with the supervisors and IT specialist to validate new tests and systems, auto verification, billing charges, ... rules and regulations in a timely and accurate fashion. + Ensure compliance with all billing related regulatory and voluntary standards of performance. Identify… more
- Evolent (Helena, MT)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- AdventHealth (Hinsdale, IL)
- …patient notifications are provided and documented in a timely manner for compliance : Important Medicare Letters (IML), Medicare Outpatient Observation ... policies and procedures and ensures quality patient care and regulatory compliance . Actively participates in outstanding customer service and accepts responsibility… more
- AdventHealth (Bolingbrook, IL)
- …patient notifications are provided and documented in a timely manner for compliance : Important Medicare Letters (IML), Medicare Outpatient Observation ... policies and procedures and ensures quality patient care and regulatory compliance . Actively participates in outstanding customer service and accepts responsibility… more
- Carle Health (Peoria, IL)
- …department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid)regarding fraud, waste and abuse. Brings any questions or ... use services to ACT clients and fulfills the ACT Substance Abuse Specialist role. Qualifications **License/Certifications:** + Valid IL Driver's License + Proof Auto… more
- Trinity Health (Grove City, OH)
- …relation between diagnosis and procedure using CPT and ICD-9 coding to ensure compliance with third party regulations. Understands Medicare , Medicaid and other ... Day Shift **Description:** Posting **Position Purpose:** + Patient Financial Specialist I; Ensures the collection of accurate and complete registration/admission… more