- McLaren Health Care (Flint, MI)
- We are looking for a Quality Administrator Medicare , to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary ... working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier...not limited to, HEDIS, CAHPS, HOS, and NCQA Standard compliance , performance projects, site audits, and any other regulatory… more
- Intermountain Health (Murray, UT)
- …Partner leads the development and management of a portfolio of high-impact Medicare products within the government programs division at Select Health, overseeing ... ongoing performance. This role is responsible for driving the success of Medicare offerings across multiple states and/or market geographies, with projected annual… more
- Covenant Health Inc. (Knoxville, TN)
- …and analysis of charges, CPT coding, modifiers and billing processes to ensure compliance with Medicare , Medicaid guidelines and other insurance payors and to ... CFOs, department managers, providers, and billing staff to maximize reimbursement within compliance guidelines for Medicare , Medicaid and other insurance payors… more
- BrightSpring Health Services (Bowling Green, KY)
- …approved sales and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct ... facility rollout meetings as needed. + Must communicate effectively with Medicare beneficiaries, their families, caretakers, nursing facility management and staff. +… more
- UPMC (Pittsburgh, PA)
- …Plan has an exciting opportunity for a Quality Assurance Coordinator in the Medicare Sales Support department. This is a full time position working Monday through ... and in office. This position is located in Pittsburgh, PA. Support the Medicare Sales Contact Center to increase sales and achieve business objectives while ensuring… more
- Fallon Health (Springfield, MA)
- …in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare benefits, including prescription ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Robert Half Finance & Accounting (Goshen, IN)
- …reporting. * Provide financial guidance and support for long-term care operations, including Medicare and Medicaid compliance . * Analyze and monitor budgets to ... reports for the finance committee and other stakeholders. * Ensure compliance with all applicable healthcare regulations and financial standards. Requirements *… more
- Penn Medicine (Philadelphia, PA)
- …letters for third party denials where appropriate * Apply the 2 midnight rule to Medicare reviews * Maintain compliance with Medicare rules as it applies ... medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, and appropriate physician… more
- The Joint Commission (Oakbrook Terrace, IL)
- …from the field, analysis of periodic performance reviews, evidence of standards compliance reports, complaints, and Medicare out-of- compliance reports. + ... inductive reasoning skills to determine a health care organization's degree of compliance with applicable standards and functionality of care delivery systems. Field… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... SLA's. With speed, accuracy, and integrity, ensures that enrollee data for Medicare Advantage, Medicare Supplement, NaviCare, Summit Elder Care, Fallon Health… more