- University Health (Seguin, TX)
- …efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed ... Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of… more
- Astiva Health, Inc (San Jose, CA)
- …and deeply personal. Based in Orange, CA, we serve a diverse community through Medicare and HMO services designed to meet people where they are. We're not just ... Provider information, ensuring the accuracy of the provider directory and compliance with regulatory requirements. . Portal Support & Training: Assist Providers… more
- ChenMed (Philadelphia, PA)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... work closely with the applicable managers and medical directors to ensure compliance with guidelines along with participating in risk and quality management… more
- Campbell County Health (Gillette, WY)
- …a timely manner. Coordination with the Billing Supervisor and MDS regarding Medicare and other payor sources qualification. * Demonstrates commitment to work ... involving health care and/or financial practices. * Complies with the hospitals Corporate Compliance Program including, but not limited to, the Code of Conduct, laws… more
- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... **Responsibilities:** + Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical Mutual's Medicare … more
- Dignity Health (Phoenix, AZ)
- …and compliance committee, on the status of Mercy Care Plan's Medicare compliance program implementation, the identification and resolution of potential or ... **Job Summary and Responsibilities** Develops, operates and administers the regulatory compliance program for both Medicare Advantage (Part C) and Medicare … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …+ Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for all formulary-based findings. Supports and acts as ... is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes...upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to… more
- Sedgwick (Baton Rouge, LA)
- …Description** + Set up new Medicare Lien Resolution (MLR) referrals in the Medicare Compliance System + Electronically sort and index Medicare mail in ... the SIR and Medicare Compliance systems + Responds to questions from examiners about Medicare Compliance processes and products + Documents activity in… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Commonwealth Care Alliance (Boston, MA)
- …reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics ... under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
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