- Atrium Health (Charlotte, NC)
- …strategy, vision, mission, and goals. Ensures competency of Clinical Documentation Specialist staff by conducting on-going reviews and skills assessments; provides ... and understanding of severity based DRG systems; All-Patient Refined and Medicare Severity (APR-DRG), Medical Severity Diagnostic Related Group System (MS-DRG) and… more
- Houston Methodist (Katy, TX)
- Medicare compliance experience is preferred ** **Note: Office for this position is located at our Continuing Care Hospital:** **701 S. Fry Rd. Katy, TX 77450** ... **. (Hybrid position)** At Houston Methodist, the CBO Regulatory Compliance Specialist position is responsible for working with Houston Methodist's Corporate Central… more
- Molina Healthcare (CA)
- …team members, and manager. Basic understanding of managed healthcare systems and Medicare . ** PREFERRED EDUCATION:** Associate's or Bachelor's Degree in Social ... Work, Human Services, or related field. ** PREFERRED EXPERIENCE:** Experience with Medicare and Medicare managed plans such as MAPD, DSNP, and MMP. To all… more
- ProMedica Health System (Toledo, OH)
- …billing, accounting, or business experience with and third party billing experience preferred . Medicare experience required. 3. Physical Demands: Work is ... Responsible for Daily Review of outstanding and incoming Medicare Additional Development Requests (ADRs). Responsibilities: 1. Maintains updated files as changes… more
- CVS Health (Franklin, TN)
- …sales team, you will learn how to help our agents grow sales in the Medicare health market while building a strong and collaborative relationship with your team. Our ... environment; Required + Microsoft Office (Excel and Outlook) computer skills; Requirement Preferred Qualifications + 1-3+ years health insurance sales, focus on … more
- Sunrise Senior Living (Arlington, VA)
- …(P&L) Summary reporting - Review balance sheet account reconciliations - Medicare /Medicaid billing - Adherence to Sunrise Senior Living business process controls ... **Qualifications:** - Associate degree in Accounting or related field preferred - Two (2) years experience in accounting field with exposure to accounting services… more
- Universal Health Services (Richmond, VA)
- …The Atlantic Region CBO is seeking a dynamic and talented Medicaid Billing Specialist . The Medicaid Billing Specialist is responsible for the accurate and ... + High School Diploma or equivalent and 1-3 years billing experience preferred . + Strong Microsoft Office skills (Excel, Word, Outlook) + Customer focused… more
- Wider Circle (Charleston, WV)
- Wider Circle is looking for a Community Engagement Specialist in West Virginia to join our circle and play a vital role in running Connect for Life, our ... Requirements + You have a high school diploma or GED; bachelors or associates degree preferred + You have a passion for helping people and serving others. + You… more
- PruittHealth (Norcross, GA)
- …AA/AS in Accounting or Business (or Equivalent Education / Experience) preferred . **MINIMUM EXPERIENCE REQUIRED:** * Demonstrates experience and a proven track ... record in Insurance Claims in a medical setting of moderate size and complexity, information systems, and patient accounting applications, as typically acquired in1-3 years of patient accounting / medical billing positions * Experience in month end close… more
- CVS Health (Richmond, VA)
- …help to support various Scorable Action Items (SAI) programs in the Medicare population, including Fraud, Waste, and Abuse (FWA), Formulary Education, Therapeutic ... for: + Performing pharmacy reviews and making evidence-based recommendations regarding Medicare members + Identifying opportunities within the health plan for… more
- The Cigna Group (Houston, TX)
- …CMS RADV audits and approaches and 2 years + of RADV coding experience is highly preferred + Familiarity with Medicare Risk Adjustment is highly preferred + ... **Job Summary:** The Medicare Coding Quality Review Audit Manager is responsible...(AAPC) in one of the following certifications, is strongly preferred : + Certified Professional Coder (CPC) + Certified Coding… more
- Commonwealth Care Alliance (Boston, MA)
- …This Role is Important to Us:** Under direction of the Director of Medicare Compliance, the primary focus areas of this position include development and oversight ... includes: Corrective Action Plan (CAP) management, regulatory reporting to Centers for Medicare & Medicaid Services (CMS), State Agencies and Department of Insurance… more
- CVS Health (Albany, NY)
- …Accountable Care organization. This position will focus on beneficiaries enrolled in Medicare Advantage plans to provide resources and assistance to drive STARS ... and allied health professionals to support the needs of Medicare beneficiaries + Speak one on one with ...states if required + Performs other duties as required Preferred Qualifications + Residency training + Board Certified Ambulatory… more
- The Cigna Group (Bloomfield, CT)
- …follow up contact, which may include primary care physician and specialist appointment scheduling. + Provide clinical assessments, health education, and utilization ... years experience in acute care, home health or case management experience. + Medicare and/or Medicaid experience with geriatric populations a plus + Certified Case… more
- Medical Mutual of Ohio (OH)
- … Specialist I** . Implements marketing strategies for consumer-facing Medicare and Individual ACA campaigns. . Develops and manages marketing collateral ... Specialist II** . Implements marketing strategies for consumer-facing Medicare campaigns. . Develops and manages marketing collateral and sales materials… more
- Martin's Point Health Care (Portland, ME)
- … Medicare Specialist ) or TRICARE (for USFHP Specialist ) appeals processes and regulations strongly preferred Skills/Knowledge/Competencies (Behaviors): ... since 2015. Position Summary Job Description Position Summary: The Appeals Specialist ( Medicare or US Family Health Plan) is responsible for ensuring… more
- InnovaCare (Ponce, PR)
- …passion and customer focus to the business. POSITION DESCRIPTION The Quality Specialist Nurse is responsible for monitoring quality of care and services delivered ... of experience in clinical nursing. Previous QA review experience preferred . GENERAL SKILLS AND KNOWLEDGE + Must have ability...management in North America. Through two it's main ways, Medicare Advantage and the provider network, we are committed… more
- PruittHealth (Macon, GA)
- …MACON or ATHENS** **JOB PURPOSE:** The purpose of the Outreach and Enrollment Specialist role for PruittHealth Premier to serve as a licensed insurance agent to ... office space/work location is provided. The Outreach and Enrollment Specialist conducts the majority of their work within local...6. Ability to learn and carry out Centers for Medicare & Medicaid Services rules and regulations. 7. Meet… more
- Humana (Miami Beach, FL)
- …and help us put health first** The Telephonic Call Center Care Coach Specialist / Care Coach 1 assesses and evaluates member's needs and requirements to achieve ... depending on business needs. **Telephonic Call Center Care Coach Specialist / Care Coach 1:** + Employs a variety of...FL 33126 depending on business needs. + During the Medicare Annual Election Period, September to December, must be… more
- Humana (Jacksonville, FL)
- …caring community and help us put health first** The Telephonic Call Center Specialist /Care Coach 1 assesses and evaluates member's needs and requirements to achieve ... of members -in Jacksonville office daily **Telephonic Call Center Specialist /Care Coach 1** + High Volume phone calls +...needs and hours could include weekends/holidays. + During the Medicare Annual Election Period, September to December, must be… more
