- Staffing Solutions Organization (Albany, NY)
- …**Basic Qualifications:** + 10 years of professional experience + 5 years of subject matter expert experience + Supervisory experience **Desired ... reflection of our clients and the people they serve. ** Medicaid Program Advisor (Level 2 or 3) in Albany,...Executive Team** **50% Onsite / 50% Remote** **Summary:** The Medicaid Program Advisor will be part of an executive… more
- Commonwealth Care Alliance (Boston, MA)
- …represent CCA to provider community and all constituents of CCA. + Serve as a subject matter expert within the department and company-wide for services ... compliance requirements. + Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services. + Conduct on-going assessments… more
- BeOne Medicines (Emeryville, CA)
- …price realization, and gross-to-net projections. + Serve as the policy and pricing subject matter expert , assessing implications of legislative and ... regulatory changes (eg, IRA negotiation, MFN, ASP reforms, Medicaid Best Price, AMP changes) and developing mitigation strategies. + Drive scenario planning,… more
- Commonwealth Care Alliance (Boston, MA)
- …liaison with external vendors + Facilitate Communications Team in content creation as the subject matter expert for provider network + Maintain inventory of ... foster strong, collaborative relationships with provider partners serving dual-eligible (Medicare- Medicaid ) members. This role ensures providers are well-informed, engaged,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Required Knowledge, Skills & Abilities (must have):** + Strong claims experience + Mentoring subject matter expert of the team + Managed Care experience ... (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience with behavioral health providers preferred + Understanding of provider… more
- Stanford Health Care (Palo Alto, CA)
- …service line opportunity, and facilitate short and long-term resolutions. + Serve as a subject matter expert and authoritative resource on interpretation and ... Abilities** + Expertise in coding and CDI practices., maintaining expertise in Medicare/ Medicaid rules and regulations, as well as current trends and developments. +… more
- Stanford Health Care (Palo Alto, CA)
- …tools, goals, policies, and procedures for the Denials Management Department. Serve as a subject matter expert on billing and coding regulations and ... detailed review of medical records. Ensure compliance with Medicare, Medicaid , third-party guidelines, Local Coverage Determinations (LCD), National Coverage… more
- DATAMAXIS (Springfield, IL)
- …distance (3 - 5 Hours) of Springfield, IL. Functional Description: This position is a Medicaid Subject Matter Expert for the Illinois Enterprise Data ... Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations. * With the specialized… more
- Molina Healthcare (Bowling Green, KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for being the SME ( Subject Matter Expert ) for Medicaid risk adjustment programs in multiple states. ... available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment is not required. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze risk score… more
- Commonwealth Care Alliance (Boston, MA)
- …overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment ... - AAPC + Certified Claims Professional (CCP) + Other AHIMA or Medicaid billing-related certifications **Required Experience (must have):** + 3+ years in healthcare… more
