• Medicare Advantage Quality Consultant

    Highmark Health (Charleston, WV)
    …government value-based reimbursement reports in the areas of Medicare STARS, Medicaid HEDIS and risk revenue and develop strategic plans to meet PCP government ... and engagement of primary care providers (PCP) enrolled in government value-based reimbursement programs and continuous improvement models. This job is a highly… more
    Highmark Health (09/22/25)
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  • Bilingual Case Manager

    Cardinal Health (Honolulu, HI)
    …processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare, Medicaid , Managed Care, and Commercial ... diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for coverage, preferred + Strong people… more
    Cardinal Health (09/03/25)
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  • Prior Authorization Technician - Remote

    Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
    …with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical ... and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their… more
    Polaris Pharmacy Services, LLC (09/11/25)
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  • Prior Authorization Supervisor

    Polaris Pharmacy Services, LLC (Covina, CA)
    …with national Medicare D plans, third party insurance companies, and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical ... and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks to Polaris and their… more
    Polaris Pharmacy Services, LLC (08/23/25)
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  • Claims Specialist

    BrightSpring Health Services (Louisville, KY)
    …with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines ... Dental, Vision, and Life Insurance + Company-Paid Disability Insurance + Tuition Assistance & Reimbursement + Employee Discount Program + 401k Plan + Paid Time Off +… more
    BrightSpring Health Services (09/20/25)
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  • Unit Supervisor

    City of New York (New York, NY)
    …HRA; it contributes to creating PEG revenue, generates additional State and Federal Reimbursement . ORMD also contributes to City-tax levy savings for the City. The ... areas to prevent potential errors by reviewing records of Cash Assistance and Medicaid Assistance Program (MAP) cases and analyzing their contents for material that… more
    City of New York (07/12/25)
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  • Clinical Documentation Specialist - Health…

    Hawaii Pacific Health (Lihue, HI)
    …overall quality of medical record documentation to ensure compliance with Medicare and Medicaid (CMS) guidelines and to expedite reimbursement . You will use both ... also generates the coding procedures for data collection, research, and reimbursement . With the widespread computerization of health records and other information… more
    Hawaii Pacific Health (09/05/25)
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  • Director of Palliative Care - Nurse Practitioner

    Gentiva (St. Louis, MO)
    …including budget development and monitoring required + Understanding of Medicare/ Medicaid and Commercial insurance billing and reimbursement **We ... Offer** + Comprehensive Benefits Package: Health Insurance, 401k Plan, Tuition Reimbursement , PTO + Opportunity to Participate In a Fleet Program + Competitive… more
    Gentiva (08/11/25)
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  • Immune Hematology Manager

    Sanofi Group (Madison, WI)
    …+ Maintain extensive knowledge of the Managed Care, GPOs, Specialty Pharmacy, State Medicaid and Veterans Affairs selling and reimbursement environment for their ... IHM must demonstrate product & disease state expertise; and product access/ reimbursement expertise. + Develop and maintain strong working relationships with various… more
    Sanofi Group (08/08/25)
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  • Director, Account Receivable

    Walmart (Bentonville, AR)
    …director or senior leader level role. + Deep understanding of payer reimbursement models, including Medicare, Medicaid , managed care, and value-based ... ensuring regulatory compliance, partnering with H&W operations teams, optimizing reimbursement cycles, and driving enterprise-wide improvements in cash flow and… more
    Walmart (07/22/25)
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