- RWJBarnabas Health (Oceanport, NJ)
- Inpatient Coding Quality Officer III - ( Medicare ) RemoteReq #:0000183242 Category:Healthcare Operations, Revenue Cycle, and Patient Access Status:Full-Time Shift:Day ... Oceanport, NJ 07757 Job Title: Inpatient Coding Quality Officer III - ( Medicare ) Location: Barnabas Health Corp Department: HIM - Coding Quality Req#: 0000183242… more
- Insight Global (Charlotte, NC)
- …will be responsible for leading the analysis and reporting of pharmacy data for Medicare programs, focusing on CMS Direct Subsidy, PDE, and MMR. The role involves ... efforts and partner with key business stakeholders. Key Responsibilities: . Analyze Medicare data, including PDE submissions, MMR reports, and CMS Direct Subsidy… more
- Community Health Systems (La Follette, TN)
- **Job Summary** The Medicare Billing Specialist is responsible for performing timely and accurate Medicare billing activities, including claims preparation, ... submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state billing… more
- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Molina Healthcare (Green Bay, WI)
- …for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare -Medicaid recipients within approved ... product features and differences. + Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and submit required enrollment… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Washington DC or any state in the US (except Hawaii).** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed ... which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies...are a Qualifying Clinical Trial as defined by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical… more
- Prime Therapeutics (Harrisburg, PA)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...CMS, and the company. Requires a working knowledge of Medicare Part D eligibility requirements, Part D plan designs,… more
- Humana (Louisville, KY)
- …hybrid based on business discretion. The MRA Finance team supports Humana's Medicare Risk Adjustment business area. The Finance team develops revenue and risk ... score projections for bids and budgets, evaluates changes in Medicare regulations and payment models, monitors and reports on risk adjustment data submissions, and… more
- AmeriHealth Caritas (Detroit, MI)
- …us at www.amerihealthcaritas.com. **Role Overview: ;** Reporting to the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care Coordinator manages care ... needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the scope… more
- US Tech Solutions (May, OK)
- …contract **Note:** + Ideal candidates must have experience of Prior Authorization, Medicare Part D and Pharmacy Benefit Management experience. + **Shift Timing:** ... As a Pharmacist Advisor you will be directly supporting Medicare Part D members and providers with requests related...and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. + This is a great… more