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Oversight of Medicaid claims, Tricare and Coverage Gap processing operations with Third Party vendor and coordination of quarterly cash flow monitoring with Treasury. Insure approval workflow of Medicaid, Tricare and Coverage Gap claims follows approval matrix and completes within payment due date cycle.
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Maintain knowledge of State and Federal specific laws, Tricare/Governmental programs, Medical Insurance Providers, Medicaid Waiver Programs and ensure compliance with regulations. Maintain knowledge of State and Federal specific laws, Tricare/Governmental programs, Medical Insurance Providers, Medicaid Waiver Programs and ensure compliance with regulations.
$75,000 - $85,000 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Our operations corporate support center and flagship clinics are in beautiful North Carolina - convenient to the mountains, beaches, professional sports teams, leading universities and world-class dining and entertainment.
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Will be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation; No Fault Auto, and commercial insurance payers. Will be knowledgeable of billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; insurance terminology; basic medical terminology, EMTALA, HIPAA privacy, and compliance practices.
Part-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Gathers provider opt-in forms for various contracted entities that fall under HOA (Medicaid CMOs, Tricare, PHS/CI, etc.) Participates in provider surveys and communications required for NCQA compliance, providing evidence through necessary reporting.
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Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines or applicable DHA approved resource and referral and TRICARE guidelines.
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Experience with military Active Duty service members and knowledge of Department of Defense (DoD), Federal, State, non-profit Healthcare systems, and organizations, to include DoD Tri-Service Military Healthcare Systems, TRICARE purchased care system, and the Department of Veterans Affairs, along with basic knowledge of the Recovery Care Coordinator program.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Demonstrates knowledge of third party payer information, including Medicare, Medicaid, VA, Tricare/UHC and commercial payers, to ensure compliance with rules and regulations to ensure accurate reimbursement.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Review and or establish subcontractor terms and conditions that are in compliance with ESA and or Customer terms and conditions. Voluntary Tricare Supplement available for military retirees.
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Administration of subcontracts for compliance with provisions set forth. Place subcontracts/purchase orders/ letter subcontracts of medium/high complexity in accordance with all required (FAR/DFAR) regulations, corporate compliance requirements, regulations and IAW Customer requirements flowed via SSOW, PWS etc.
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State and federal government funding programs such as Medicare, Medi-Cal, CCS, TRICARE/CHAMPUS, Workers' Compensation; and commercial insurance payers; billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; medical and insurance terminology; HIPAA privacy and compliance practices.
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As TriWest’s hybrid cloud and cybersecurity services partner, IBM is responsible for the delivery of the TRICARE Managed Care Support (MCS) T-5 contract. IBM’s scope is to provide hosting, platform engineering, infrastructure automation, managed operations, and security and compliance of the T-5 environments in Microsoft Azure for Government (MAG.
$81,000 - $151,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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The Exec. Director is responsible for the development, implementation, communication, and monitoring of all compliance activities and regulatory guidance for the Plans' four payer lines of business, consisting of Medicare Advantage, Medicaid managed care, the Department of Defense's TriCare program and commercial employer group (self-funded.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Tricare and military health experience preferred. Responsible for operational performance and regulatory compliance of USFHP, in accordance with Department of Defense (DoD) and other applicable requirements.
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Highlights Healthcare provides diagnosis and early intervention ABA therapy services to bring meaningful and positive change to children with autism. Ability to obtain and maintain a clear criminal record/fingerprint clearance from the Department of Justice and Federal Bureau of Investigation per HHC and/or program requirements.
ExpandApply NowActive JobUpdated 8 days ago
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