- CenterWell (Nashville, TN)
- …financial data driven methods to develop and influence drug strategies for the Medicaid lines of business. + Utilizes broad understanding of pharmacy, managed care, ... PBM, market and regulatory insights to support the development of Medicaid formulary and medical drug strategies to mitigate Humana's costs and trend while improving… more
- Vanderbilt University Medical Center (Nashville, TN)
- …for payor enrollment denials and rejections for both Hospital Billing and Professional Billing. + Discretion & Privacy (Intermediate): Using and keeping information ... explain rules and regulations that are ambiguous or unclear. Our professional administrative functions include critical supporting roles in information technology… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Senior Market Finance Professional collects, analyzes and reports on various market data to connect ... financial outcomes with operational effectiveness. The Senior Market Finance Professional work assignments involve moderately complex to complex issues where the… more
- Humana (Nashville, TN)
- …from the data exchange between Humana and its trading partners, Medicare and Medicaid . The Senior Encounter Data Management Professional will work with ... and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of… more
- Humana (Nashville, TN)
- …community and help us put health first** The IFG Senior Compliance Professional ensures compliance with Health Plan contracts and governmental requirements. The ... Senior Compliance Professional work assignments involve moderately complex to complex issues...and reporting **Preferred Qualifications** + Bachelor's degree in Business, Finance , Law, Healthcare Administration, or a related field +… more
- Covenant Health Inc. (Knoxville, TN)
- …Forbes "Best Employer" seven times. Position Summary: Performs complex level professional internal auditing work. Work involves compliance audit projects for ... may participate in requested investigations. Maintains all organizational and professional ethical standards. Works independently under limited supervision with… more
- Prime Therapeutics (Nashville, TN)
- …flows, process change and/or project management in supporting Compliance with Medicaid requirements. + Provide direct, or indirect leadership to other compliance ... + Advise internal clients regarding compliance with State and Federal Medicaid regulatory and contractual requirements + Provides leadership to the business… more
- Elevance Health (Nashville, TN)
- …Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services ... to Medicaid plans in partnership with blue cross blue shield...minimum of 10 years of experience in healthcare operations, finance , underwriting, actuary, network development, and/or sales; or any… more
- Elevance Health (Nashville, TN)
- …contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The **Audit and Reimbursement II** ... Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services).… more
- Humana (Nashville, TN)
- …& Clinical Innovation + Corporate Strategy & Transformation Office + Medicare & Medicaid Market Operations + Provider Relations & Network Performance + Marketing & ... Customer Engagement (including MarketPoint) + Finance , Accounting & Risk Management + Human Resources &...in a Master of Business (MBA) or other advanced professional degree (eg MPH, MD, JD, Ph.D.), with a… more