- Henry Ford Health System (Troy, MI)
- …pharmacy benefits at Health Alliance Plan (HAP), with a primary focus on Medicare Part D and broader enterprise pharmacy strategy. This role provides actuarial ... Duties and Responsibilities + Lead the development, submission, and validation of Medicare Part D bids, ensuring compliance with CMS requirements and incorporating… more
- Corewell Health (Livonia, MI)
- …information, educating and providing information as necessary. Collects and documents Medicare Questionnaire, issue Medicare Inpatient Letter & Medicare ... Performs medical necessity check and issue ABN as appropriate for Medicare primary outpatients. Note: excluding lab-only outpatients effective September. + Affix… more
- University of Utah Health (Salt Lake City, UT)
- …+ This position is responsible to work with the acutely admitted Traditional Medicare , Medicare Advantage, Commercial, Federal, State and unfunded patients. + It ... to specific condition. + Participates in organization Utilization Review Committee, weekly Medicare IPPS Case Reviews & RAC Audit Case Reviews. + Evaluates reports… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …other plans, insurance companies, Social Security Administration and Centers for Medicare and Medicaid Services (CMS). **QUALIFICATIONS** **Education** + High School ... time. + Account Advisor Is who work on the Medicare LOB must be able to follow CMS (Center...LOB must be able to follow CMS (Center for Medicare and Medicaid) standards including but not limited to:… more
- Humana (Indianapolis, IN)
- …bid process. This role includes competitive analysis, project management, Medicare Advantage plan design and implementation, and cross-functional leadership. ... bid process. This role includes competitive analysis, project management, Medicare Advantage plan design & implementation, and cross-functional leadership. Strategic… more
- New York State Civil Service (Marcy, NY)
- …individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program). ... appointed you may be required to become an enrolled Medicare provider; obtain and provide to your employer a...to allow for your services to be billed through Medicare and Medicaid. If you are appointed and you… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under minimal ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Serves as the ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind… more
- Rush University Medical Center (Chicago, IL)
- …reporting period. Maintains historical list of all settlements/verdicts with a Medicare beneficiary reported to CMS by RUMC/ROPH. + Reports required information ... Reports and confirmation of receipt by EDI representative. + Coordinates Medicare Secondary Recovery Reporting Portal (MSPRP) requests for conditional and final… more
- TEKsystems (Morrisville, NC)
- …explain benefits offered by all payer types including private/commercial and government (ie, Medicare , Medicaid, VA and DOD); with expertise in Medicare Part B ... for conflict resolution as needed. Skills Prior authorization, Pharmacy, Medicare , Insurance verification, reimbursement, Care coordination, insurance billing, Health… more