- Insight Global (Charlotte, NC)
- …drug events . Work with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage . Lead process ... partner with key business stakeholders. Key Responsibilities: . Analyze Medicare data , including PDE submissions, MMR reports,...to project yearly Medicare changes . Ensure data accuracy and compliance with CMS guidelines… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The ... Medical Director work assignments involve moderately complex to complex issues...to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The… more
- Molina Healthcare (Syracuse, NY)
- **Job Description: Director , Operational Oversight ( Medicare )** **Job Summary** Responsible for planning, developing and directing the implementation of ... and resolve. **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to… more
- Humana (Lansing, MI)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance , Healthcare Medical Claims Coding ... and report outcome results on edits implemented. + Utilize data to examine large claims data sets...public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity… more
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...accurate financial account setup. + Tracks and monitors census data to identify discrepancies and resolve issues impacting billing.… more
- Commonwealth Care Alliance (Boston, MA)
- …of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the ... Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in… more
- Houston Methodist (Katy, TX)
- …Access Services, and Utilization Review as needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid ... position provides guidance to staff and is responsible for staffing, budget compliance , contributing to staffing decisions such as hiring and terminating employment,… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the Assistant Director , the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical necessity ... care, prior authorization and denial management, education and provider support, and data and quality reporting for referrals for Medicare Advantage population… more
- Molina Healthcare (Caldwell, ID)
- …demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan, monitoring and reporting ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more