- Insight Global (Philadelphia, PA)
- Job Description A leader in the health insurance space (Medicaid/ Medicare ) space is actively hiring for a REMOTE Sr. Business Systems Analyst to own the ... requirements of their Pharmacy Benefits Management (PBM) business platform. This is a small IT Team of 3 people that are all responsible for delivering technical projects for the PBM line of business. As the Systems Analyst you will leverage your SDLC… more
- CareFirst (Baltimore, MD)
- …in Business or Healthcare Administration. + Knowledge of healthcare or health insurance payor industry ( Medicare , Medicaid, Commercial, DSNP and other payor ... programs), including legal and regulatory requirements. + Solid understanding of CPT-4, HCPCS, revenue and ICD coding, medical terminology, claims payment, contract negotiations and problem resolution. **Knowledge, Skills and Abilities (KSAs)** + Understanding… more
- Fallon Health (Springfield, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief ... of summary of purpose:** Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice. **Competencies:** Demonstrates commitment to the… more
- Fallon Health (Worcester, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive ... Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Risk Adjustment Analyst (RAA) will be a SME for the MassHealth risk adjustment model(s) and related data… more
- Hackensack Meridian Health (Edison, NJ)
- …reviews of all Access data elements, such as real time eligibility (RTE), Medicare Payer Secondary Questionnaire (MSPQ), Insurance plan codes, proper sequencing ... of COB (Coordination of Benefits), and reviews physician licensure. Works with Access assigned Work Ques (WQs) to correct the edits causing the stop bills. Included in this is the compilation of edit findings to provide management with a tool to provide… more
- Fallon Health (Springfield, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief ... summary of purpose:** Performs a variety of duties involving clinical and administrative patient care in accordance with applicable standards of practice. Provides assessment and care to PACE participants at the direction of the SE Clinic Supervisor, SE… more
- Fallon Health (Worcester, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive ... Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** This position is responsible for providing actuarial analytic support to various departments and company key… more
- Fallon Health (Lowell, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief ... Summary of Purpose:** The SE Licensed Practical Nurse will be an active member of the Summit ElderCare Care Team to ensure participants receive high quality and timely care and support whether at the PACE center or in the community. The SE Licensed Practical… more
- Fallon Health (Springfield, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Position ... Overview:** Our Physicians have flexibility to devote as much time as needed for the clinical and social needs of our participants and their caregivers to provide individualized quality care by a team of geriatric care professionals who work together with… more
- Fallon Health (Worcester, MA)
- …hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief ... summary of purpose:** Provides personal care to PACE participants both in the PACE center and out in the community, when necessary; exercises independent judgement; reports any changes in participant status to the IDT in morning meeting or as needed; Provides… more