- Stanford Health Care (Palo Alto, CA)
- …synchronization between clinical activity, revenue capture and clinical documentation. + Ensures compliance with federal and state laws pertaining to the revenue ... + Knowledge of Medicare , Medicaid and other third-party billing coverage and compliance issues. + Knowledge of CMS and State coding standards and charge capture… more
- Humana (Providence, RI)
- …industry in how digital can be used to drive customer acquisition in the Medicare Advantage space. Within this business area, we are aggressively driving new digital ... of working, and employing next-gen technology to revolutionize how Medicare Advantage is sold. This role is part of...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Calvert Memorial Hospital (Prince Frederick, MD)
- …healthcare by coordinating, performing and completing or supporting the Welcome to Medicare (WTM) and Annual Wellness Visit (AWV) to a specified panel of ... Medicare (or Medicare eligible) patients. This activity...and leaders informed. Ability to make independent decisions in compliance with CalvertHealth policies and procedures. + Maintain integrity,… more
- Humana (Louisville, KY)
- …Activation Principal develops, implements, and manages oversight of the company's Medicare /Medicaid Stars Program. Directs all Stars quality improvement programs and ... years of quality improvement and/or developing and advancing enterprise strategy + Medicare Advantage experience + CMS Stars program experience + Previous leadership… more
- Humana (Oklahoma City, OK)
- …RN or a related field, or equivalent work experience + Experience with Medicare and/or managed care + Understanding of NCQA and CMS Stars Rating System ... Care/Administration, RN or a related field + Experience with Medicare Risk Adjustment and/or medical coding + Proven organizational...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Montpelier, VT)
- …to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud, Waste, and Abuse in ... a group of seasoned professionals. + Proven knowledge in Medicare regulations + Excellent PC skills MS Excel and...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Frankfort, KY)
- …in reporting tools such as SSRS or SSIS + Knowledge of Medicaid or Medicare services + Advanced data analytics skills and reporting experience to include working ... or related field + Experience working with Medicaid and Medicare data + Expertise in creating analytics solutions to...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Commonwealth Care Alliance (Boston, MA)
- …enhance the risk adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent ... in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal candidate is a… more
- CenterWell (Port Arthur, TX)
- …for TB. **Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number/ Medicaid Provider Number + Experience managing Medicare ... in a value based relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Walmart (Orlando, FL)
- …on policy changes and new regulations; researching information to accurately process Medicare orders to ensure compliance ; and interpreting and documenting ... services to patients in accordance with local, state, and federal laws and corporate policies and procedures by assisting...a safe and clean work environment. + Complies with Medicare and Medicaid policies and procedures by implementing and… more