- AssistRx (Orlando, FL)
- …comply with all federal, state, and industry regulations, including anti-kickback statutes, Medicare /Medicaid rules, FDA and OIG guidance. + Work closely with the ... with pharmaceutical manufacturers and understanding of third-party payer systems (commercial, Medicare , Medicaid). Skills & Competencies: + . Strong leadership and… more
- Sanford Health (WI)
- …across all core product lines, including Individual ACA, Employer Group, Medicare Advantage, and TPA/Self-Funded plans. Builds strategic and long-term relationships ... in health insurance industry, with multi-line product knowledge (ACA, Group, Medicare , TPA). Demonstrated success in both new business growth and member/broker… more
- Nuvance Health (Danbury, CT)
- …to documentation and coding. . Comprehensive knowledge of official coding guidelines, Medicare rules and regulations, ICD-10, HCPCS, E/M, and CPT coding. Must ... demonstrate efficiency, collaboration, candor, and results orientation. . A vast knowledge of case mix index and clinical documentation integrity initiatives to enhance performance is preferred. . The ability to effectively collaborate with physicians and… more
- Granville Health System (Oxford, NC)
- …required. # #Strong communication skills both written and oral, team player. # Medicare and Medicaid regulatory knowledge a must. Preferred:##Two years experience in ... a similar position within a hospital is preferred. #Meditech system experience preferred. # more
- City of New York (New York, NY)
- …Program, Management Benefits Fund, Employee Assistance Program, Work Well NYC, Medicare Part B Reimbursement and Pre-Tax Benefits & Citywide Programs including ... the Deferred Compensation Plan and NYCE IRA. In addition to negotiating collective bargaining agreements, OLR serves as a resource to agencies with regard to workforce labor issues and works with the Municipal Labor Committee (MLC) to pursue innovations in a… more
- Molina Healthcare (IA)
- …successful launches of new processes, systems, and operational models across Medicaid, Medicare , and Marketplace lines of business. We are seeking a leader with ... proven experience in **launch planning, execution, and post-implementation stabilization** . **Key responsibilities include:** + Leading operational readiness efforts for new processes, systems, and operational initiatives across provider data and… more
- CVS Health (Hartford, CT)
- …and GAAP PDR calculations. + Complete annual gross premium valuations for Medicare Supplement business. + Manage the relationship with the external vendor for ... cash flow testing work, in support of long duration businesses in a number of statutory legal entities. + Lead vendor payment workstream in support of statutory medical loss ratio reporting. + Provides required materials and responds to internal and external… more
- Intermountain Health (Murray, UT)
- …more than 1 million members. Select Health's line of businesses include Medicare , Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and ... self-funded Commercial Employer plans. This leader is responsible for the development, implementation, evaluation, and operational management of care management programs for the line of business(s) which this position oversees. The position requires an… more
- BrightSpring Health Services (Clearwater, FL)
- …with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case ... conferences and other client-related meetings + Chairing committees as appropriate, safety, infection control, incident review, and human rights committees + Facilitating communication and serving as a liaison between and among nursing and direct care staff,… more
- BrightSpring Health Services (Corpus Christi, TX)
- …with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case ... conferences and other client-related meetings + Chairing committees as appropriate, safety, infection control, incident review, and human rights committees + Facilitating communication and serving as a liaison between and among nursing and direct care staff,… more