- CenterWell (Honolulu, HI)
- …home care. + Extensive experience in working with Payer requirements, both traditional Medicare and Medicare Advantage plans, ADR requests, Denials, Appeals, ... quality assurance or teaching position in/or related to a Medicare certified home health agency. + A thorough knowledge...agency. + A thorough knowledge of federal regulations and Medicare requirements is required along with analytical skills to… more
- Highmark Health (Blue Bell, PA)
- …to ensure comprehensive and accurate diagnosis coding for risk adjusted government programs ( Medicare Advantage , ACA business, and Medicaid). Also work with Care ... for risk revenue management for all government program products (commercial ACA, Medicare , and Medicaid). Establishes the strategic direction for the Risk Revenue… more
- Humana (Albany, NY)
- …new contracting models for value-based care providers, evolving key facets of the Medicare Advantage growth strategy, and identifying high level operating model ... in the country. Role Overview The Insurance Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises the… more
- Martin's Point Health Care (Portland, ME)
- …a matrix management environment. Job Description Key Outcomes: + Support the annual Medicare Advantage and Prescription Drug (MA/PD) bid development by working ... the company, including responsibility for the actuarial support of Medicare product bids, US Family Health Plan (USFHP) rate...claims (IBNR). + Prepare and analyze monthly estimates for Medicare Part D settlement estimates. + Develop and maintain… more
- OhioHealth (Columbus, OH)
- …Integrated Network. This includes the OhioHealth Clinically Integrated Network (CIN) Medicare Advantage and Commercial contracts, OhioHealth Venture Medicare ... Actively participates in team activities such as Gemba walks. 10%: Medicare , Medicaid, and commercial program knowledge Analyze and communicate relevant policy… more
- CenterWell (San Antonio, TX)
- …of two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... care environment in a value-based relationship environment + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality indicators **Additional… more
- CenterWell (Deerfield Beach, FL)
- …of two to five years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum...in a value based relationship environment . Knowledge of Medicare guidelines and coverage . Bilingual is a plus… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …value-based commercial health plans and is in-network with major insurance plans. KelseyCare Advantage , a Medicare Advantage plan offered to Houston-area ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Kelsey-Seybold Clinic (Houston, TX)
- …value-based commercial health plans and is in-network with major insurance plans. KelseyCare Advantage , a Medicare Advantage plan offered to Houston-area ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Kelsey-Seybold Clinic (The Woodlands, TX)
- …with major insurers to offer value-based commercial health plans. KelseyCare Advantage (https://www.kelseycareadvantage.com/) , a Medicare Advantage plan ... Clinic, has achieved the coveted 5-out-of-5-star rating from the Centers for Medicare and Medicaid for six consecutive years. Kelsey-Seybold has been recognized by… more
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