- Houston Methodist (Katy, TX)
- …to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. + Ensures optimization of timely cash ... Outpatient Prospective Payment Systems, etc. + Stays informed of the latest Medicare , Medicaid and commercial payor news, updates, and regulations and adjusts… more
- US Tech Solutions (May, OK)
- …Benefits Manager (PBM) **Skills:** + MUST HAVE MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE 6 months of experienced with Prior ... Authorization(required). + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) experience. **Education:** + Pharm D. required… more
- Highmark Health (Montgomery, AL)
- …experience in managed care pharmacy + 2 years of clinical account management experience in Medicare as part of the 4 year managed care experience + 2 years of ... experience analyzing pharmaceutical cost of care data **Substitutions** + None **Preferred** + Masters of Pharmacy or Masters of Business Administration + AMCP-ASHP accredited residency in managed care pharmacy + Experience leading or participating in Pharmacy… more
- Guidehouse (Lewisville, TX)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & CMS ... 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients in all requested… more
- Centene Corporation (New York, NY)
- …auditing, project management, or business analysis experience, preferably within the Medicare field. Previous experience coordinating cross functional teams on large ... scale projects. Ability to evaluate, understand, and communicate regulatory and business requirements. Demonstrated understanding of relationships and dependencies between functional areas. This position is remote within the state of New York. Candidates must… more
- Providence (Beaverton, OR)
- …them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care coordination, case management and ... care management services to Providence Health Plans(PHP) members + Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease + Case management services include: triage and… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicare Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and integrity of ... key risk adjustment performance metrics through coordination of analytical processes, investigation and interpretation of CMS risk score methodology, risk score calculation, enrollment, premiums, medical and pharmacy claims, and provider data. Incumbent is… more
- Specialty Rx, Inc. (Ridgefield Park, NJ)
- Job Description SpecialtyRx is a full-service pharmacy. We need Medicare Part B- Billing Representative with Pharmacy experience in our Ridgefield Park, NJ location. ... Hours: 8:00am-4:00pm, 9-5 or 10-6pm Monday through Friday Must be able to train for 3 weeks onsite with the potential in going remote. Please apply here https://secure3.saashr.com/ta/s6337.careers?CareersSearch and we will be glad to reach out to you to… more
- BlueCross BlueShield of North Carolina (NC)
- …9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + The opportunity ... to work at the cutting edge of health care delivery with a team that's deeply invested in the community. + Work-life balance, flexibility, and the autonomy to do great work. + Medical, dental, and vision coverage along with numerous health and wellness… more
- Amazon (FL)
- …Application deadline: Jan 8, 2026 As a Program Manager II on the One Medical At -Risk team, you will be the primary builder of new and existing capabilities and ... programs aimed at improving health outcomes for our at-risk patient populations. Working within Amazon's mission to be Earth's most customer-centric company, you will drive operational improvement and strategic initiatives from concept to implementation,… more