- Providence (San Pedro, CA)
- …utilization of unit services in accordance with current Center for Medicare /Medicaid Services (CMS) guidelines and regulations. Under the direction of the ... Medical Director the Admissions Coordinator evaluates internal and external referrals...target LOS and expected reimbursement and cost for all Medicare patients. Providence Little Company of Mary Medical Center… more
- Molina Healthcare (El Paso, TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may require remediation...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
- Humana (Phoenix, AZ)
- …mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring compliance with governmental requirements for ... experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of… more
- Molina Healthcare (Cincinnati, OH)
- …oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This role has ... experience in related job. + 2 years minimum in Director level role or above. + Extensive understanding of... level role or above. + Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including… more
- Hackensack Meridian Health (Edison, NJ)
- …of positive change. Under the general direction of the **Physician Billing (PB) Director of Coding and Manager of Education and Audit** , this position supervises ... conducts audits for medical provider documentation while adhering to Centers for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG)… more
- City and County of San Francisco (San Francisco, CA)
- …but are not limited to: + Disease Prevention and Control Senior Specialist/Medical Director + Provides clinical oversight of a unit or clinic within the Disease ... meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider… more
- Virtua Health (Cherry Hill, NJ)
- …to ensure an outstanding customer experience. Consults with Lead Physicians, Director of Practice Management, Medical Directors and staff concerning practice ... or ambulatory medical setting. Knowledge of insurance (ICD-9 CPT coding, Medicare regulations, state regulations, CLIA, DOH, and OSHA regulations) preferred. Solid… more
- Saint Francis Health System (Tulsa, OK)
- …knowledge of healthcare billing and reimbursement processes, particularly related to Medicare and Medicaid. Essential Functions and Responsibilities: Assists in the ... oversight to sales tax recovery for taxable items utilized directly on Medicare and Medicaid patients. Decision Making: Independent judgement in making decisions… more
- Organon & Co. (Plymouth Meeting, PA)
- …state government pricing programs, including Medicaid Drug Rebate Program (MDRP), 340B, Medicare Part B/D, and the Veterans Affairs (VA)/Department of Defense (DOD) ... GP. The role reports to US Market GP Associate Director (GP AD), supports and works closely with the...the pharmaceutical industry. + Strong knowledge of Medicaid, 340B, Medicare Part B, and VA pricing rules and requirements.… more
- City of New York (New York, NY)
- …affordability programs; Aged 65 or older, Blind and Disabled (ABD) Medicaid and Medicare Savings program (MSP); applying for Medicare ; and other government ... participate in the job application or interview process, contact Sye-Eun Ahn, Director of the Office of Equal Employment Opportunity, at ###@health.nyc.gov or ###.… more