- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... **Responsibilities:** + Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical Mutual's Medicare … more
- CVS Health (KS)
- …And we do it all with heart, each and every day. **Position Summary** The ** Medicare Compliance Consultant** is a compliance role that supports the ... partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop and… more
- Insight Global (Charlotte, NC)
- …Subsidy allocations . Work with Finance and Account Management to project yearly Medicare changes . Ensure data accuracy and compliance with CMS guidelines ... with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage ....IT, Account Management, and Compliance to optimize Medicare data usage . Lead process improvement through developing… more
- Ochsner Health (New Orleans, LA)
- …as resource to company employees and management in applying and improving compliance policies, procedures and processes. Perform Medicare Coverage Analysis (MCA) ... system. + Creation, revision, and management of documents related to Medicare coverage analysis and compliance with Medicare rules and regulations + Meet… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director, Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational ... compliance with state and federal healthcare regulations, particularly MassHealth...federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims… more
- CVS Health (CT)
- …highly regulated function, this role will also oversee delegated PBM functions, cross Medicare Pharmacy Organizational Compliance with CMS regulations as well as ... implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of… more
- Commonwealth Care Alliance (Boston, MA)
- …reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics ... under the direction of the Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing… more
- CVS Health (CT)
- …monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis * Develop ... Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part C...subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… more
- Insight Global (Pleasanton, CA)
- … Medicare claims for outpatient mental health services. This role ensures compliance with Medicare regulations and supports the clinic's financial health ... services. * Apply correct CPT, HCPCS, and ICD-10 codes in compliance with Medicare rules. * Ensure documentation meets "medical necessity" requirements. * Track… more
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