- CVS Health (OH)
- …And we do it all with heart, each and every day. **Position Summary** The ** Medicare Compliance Consultant ** is a compliance role that supports ... partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop and… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
- Baylor Scott & White Health (Columbus, OH)
- JOB SUMMARY The Third Party Compliance Consultant Sr performs ongoing activities related to the development, implementation, maintenance of, and adherence to ... a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance... Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and entities on … more
- Humana (Columbus, OH)
- …customers at the center of everything it does. The Growth Strategy Consultant (Distribution) provides data-based strategic direction to identify and address business ... support for the Enterprise Growth vertical. The Long-term Growth Strategy Consultant 's work involves moderately complex assignments performed with limited direction… more
- Humana (Columbus, OH)
- …community and help us put health first** The CenterWell Strategy Senior Consultant provides data-based strategic direction to support broader team and identify and ... business segments or the company at large. The Senior Consultant works on problems of diverse scope and complexity...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Prime Therapeutics (Columbus, OH)
- …passion and drives every decision we make. **Job Posting Title** Pharmacy Network Consultant Sr - Remote **Job Description** The Pharmacy Network Consultant Sr ... pharmacy networks composition to assess network adequacy, contracting gaps and compliance with regulations + Represent Network Management department in audits and… more
- Elevance Health (Mason, OH)
- **Provider Contract/Cost of Care Consultant ** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, ... as required by law. The **Provider Contract/Cost of Care Consultant ** provides analytical support to the Cost of Care...Uses analytic tools to track both health risks and compliance , as well as supporting the contract negotiation process.… more
- CVS Health (OH)
- …to be auditing against the use of clinical criteria, policy procedures, and for compliance purposes. Schedule is Monday - Friday 8:00am - 5:00pm. Will have to ... preferred + Auditing experience + Managed care experience + Medicaid and/or Medicare experience + Systems experience: MedCompass and/or QNXT + Critical thinking… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Group ... standard formulas and actuarial information, recognizing system requirements and ensuring compliance with state and federal regulations, and adherence to internal… more
- Humana (Columbus, OH)
- …Adhere to established guidelines and procedures to ensure consistency and compliance . **Potential Duties** + Advocate for our agile development approach and ... with the organization's strategy and long-term goals. + Serve as a consultant to application teams, guiding them in creating enterprise-grade applications that… more
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