- CVS Health (Columbus, OH)
- …every day. **Position Summary** Reviews, analyzes, negotiates, and executes complex Medicaid contracts with health systems, physician groups, and behavioral health ... and enhance provider networks while meeting and exceeding accessibility, compliance , quality, and financial goals and cost initiatives. Collaborates… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Certified Professional Coder (CPC) - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid billing-related certifications **Required ... Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr . Analyst plays a critical role in ensuring accurate, compliant, and timely… more
- Humana (Boston, MA)
- …claims operations, and other business teams involved in the administration of Medicaid business at Humana. The Senior Business Intelligence Engineer will ... development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root… more
- The Cigna Group (Bloomfield, CT)
- The Director of Medicaid and Marketplace Strategy leads a team of Client Strategists to support health plan clients in achieving quality and regulatory goals, ... of a roadmap that enables Express Scripts to differentiate itself, while ensuring compliance with all requirements. Ability to assess the market and identify key… more
- Mount Sinai Health System (New York, NY)
- …and Ancillary Contracts across the Mount Sinai Health System. MSHP seeks a Senior Contract Compliance ( Professional Billing) Analyst who will primarily ... to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's...be responsible for tracking, trending, and analyzing professional billing (PB) contract compliance issues. This… more
- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Senior Risk Management Professional identifies and analyzes potential sources of loss to ... minimize risk. The Senior Risk Management Professional work assignments involve...implements controls and cost-effective approaches to minimize risk of Medicaid operations within Humana's Payment Integrity Unit. Assesses and… more
- Humana (Annapolis, MD)
- …community and help us put health first** The Value Based Market Support Senior Professional is responsible for providing comprehensive market support across ... Responsible for end to end market support for assigned Medicaid markets to ensure markets achieve their VBP contract...+ Consult with market on VBP strategy to ensure compliance with contractual requirements and market goals + Provide… more
- Molina Healthcare (Chicago, IL)
- …and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality ... more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-, program-, and… more
- CDS Life Transitions (Webster, NY)
- Summary: The Senior Compliance and Quality Specialist is responsible for coordinating and monitoring PCC's internal audit and validation processes. This role ... and maintaining policies, procedures, and standard operating procedures related to compliance and quality. + Coordinate, assign and manage audit schedules. +… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Senior Data & Reporting Professional tests the overall network in each county of ... to ensure the network is strong enough to support serving customers. The Senior Network Adequacy Professional work assignments involve moderately complex to… more