- RWJBarnabas Health (Oceanport, NJ)
- …and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines. + Critically analyzes each Medicare inpatient medical record to ... sustain an excellent organizational average accuracy rate. Adherance to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines… more
- Commonwealth Care Alliance (Boston, MA)
- …reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics ... under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
- Humana (Lansing, MI)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Providence (OR)
- **Description** **Quality Program Manager - Health Plan Medicare Advantage Stars** **_Remote_** **The Quality Program Manager - Health Plan Medicare Advantage ... interventions that result in improved Star ratings.** **The Health Plan Medicare Advantage Stars Quality Program Manager will:** + Develop and implement… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal , state, and local ... any state in the US (except Hawaii).** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical...which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies… more
- Humana (Concord, NH)
- …service should be authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which may include national clinical ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- CVS Health (Hartford, CT)
- …monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis * Develop ... Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part C...will be considered for employment in accordance with all federal , state and local laws. We are an equal… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Analyze MassHealth and Medicare claim reimbursements to ensure compliance with contractual terms, state and federal regulations, and internal ... Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in… more
- Prime Healthcare (Ontario, CA)
- …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... new members to join our corporate team! Responsibilities The Senior Medicare -Medicaid Biller/Collector is responsible for both billing and collections, gathering and… more
- Highmark Health (Harrisburg, PA)
- …A key responsibility is the creation, revision and management of spreadsheets related to Medicare coverage analysis and compliance with Medicare rules and ... Health Network **Job Description :** GENERAL OVERVIEW: Responsible for the Medicare Coverage Analysis (MCA) for sponsored projects within WPAHS, budget development… more