- NTT DATA North America (Plano, TX)
- …Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals. Desire experience specifically for processes for clinical...accordance with federal and state laws. + Identify potential compliance risks and implement corrective actions + Collaborate with… more
- Baystate Health (Springfield, MA)
- …decisions. Regulatory Knowledge: A solid understanding of healthcare regulations, compliance , and reimbursement methodologies, such as Medicare , Medicaid, ... expert on reimbursement and regulatory rules 2) Will be responsible for hospital Medicare and Medicaid cost report filings, audits, and settlements 3) Will advise… more
- Humana (Lansing, MI)
- …Clinical Leadership teams to ensure utilization reviews comply with Centers for Medicare & Medicaid Services (CMS) regulations as well as Michigan Dual Special ... and Human Services (MDHHS) standards. + Works in conjunction with Humana's Medicare UM Committees to ensure adoption and consistent application of appropriate… more
- Humana (Raleigh, NC)
- …the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. **Required Qualifications** + MD or DO degree + 5+… more
- East Boston Neighborhood Health Center (Revere, MA)
- …provider documentation and coding practices for accuracy, completeness, and compliance with payer and regulatory guidelines. + Independently conduct reviews/audits ... laws, and regulations. + Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional… more
- Molina Healthcare (San Francisco, CA)
- …procedures, and provider communications. Oversees Managers and Specialists to ensure compliance with federal, state, and local regulatory requirements while aligning ... strategic goals. Partners with network contracting, operations, government contracts, compliance , and systems teams to drive operational excellence, regulatory… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Group ... standard formulas and actuarial information, recognizing system requirements and ensuring compliance with state and federal regulations, and adherence to internal… more
- CenterWell (Kansas City, KS)
- …in on-call rotation and support growth initiatives at your center. + Ensure compliance with all licensing and accreditation requirements. **Use your skills to make ... **Preferred:** + Experience in value-based care, primary care or Medicare Advantage settings. + Active DEA license and ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Hermitage, TN)
- …in on-call rotation and support growth initiatives at your center. + Ensure compliance with all licensing and accreditation requirements. + Spend 100% of your time ... experience. + Experience in value-based care, primary care or Medicare Advantage settings. + Active DEA license and ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Corewell Health (Trenton, MI)
- …information, educating and providing information as necessary. Collects and documents Medicare Questionnaire, issue Medicare Inpatient Letter & Medicare ... by Government mandates. Scan appropriate documents. Manage all responsibilities within Compliance guidelines as outlined in the Hospital and Department Compliance… more