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Research legal issues and provide expertise in the underlying laws and regulations governing tax-qualified plans administered by WEX Health (e.g., FSAs, HRAs, HSAs, transit, wellness), including ERISA, HIPAA, the Internal Revenue Code, and Medicare/Medicaid regulations.
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Understanding of various insurance methodologies, including Medicare, Medicaid, and Managed Care insurance. Experience in healthcare sales, clinical liaison, long-term care nurse or case manager.
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Identify and verify patient's insurance in line with Medicare, Medicaid, and other Managed Care requirements. The Home Health RN Intake Coordinator is responsible for managing the smooth transition of patients into the home health environment.
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We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. The Medicare Authorized Representative will grow membership through various sales and marketing initiatives; including conducting face-to-face sales enrollment meetings, communities and providers education sessions to existing and potential members.
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Monitors situations for fraud, waste, and abuse of Medicare/Medicaid benefits and reinforces HIPAA and PHI protocols. Clinical/ambulatory care pharmacist experience. Specialty Pharmacy, 340B and/or contract pharmacy experience.
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WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
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These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. About Us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company.
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As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
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Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Job Details:This position is responsible for coordinating the oversight of compliance programs of all Medicare First Tier, Downstream and Related Entities (FDRs) and identified vendors to ensure compliance with all state and federal regulations and have effective compliance programs to prevent, detect and re-mediate noncompliance.
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Steward received a perfect 100% quality rating by the Center for Medicare and Medicaid Service's (CMS) Medicare Shared Savings Program (MSSP) in 2020. Founded in 2010, Steward Health Care is the nation's largest accountable care organization (ACO), with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through its network of hospitals, urgent care centers, skilled nursing facilities, and behavioral health services.
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Extensive experience in healthcare contracting, with a critical understanding of PBMs, National Health Plans, Medicare Part D/B, GPOs, VA/DoD, Medicaid, and the evolving market landscape.
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Abt Global seeks an experienced CMMI researcher (Senior Associate) to play a leadership role in our work with the Centers for Medicare and Medicaid Services (CMS). The successful candidate will have extensive experience in healthcare policy, program operations, and delivery and a strong interest in working on alternative payment and delivery models tested by CMS’ Center for Medicare and Medicaid Innovation (CMMI.
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Demonstrated experience managing projects as related to various government mandates, including Centers for Medicare & Medicaid Services (CMS) and state Department of Insurance agencies preferred.
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In cooperation with the market access account management team, the Contract Operation & Pricing Executive/Senior Director is accountable for managing Sobi relationship with government agencies and purchasing organizations (VA, FSS, 340 B, Medicaid, Medicare, CMS, Payers, Wholesale Distributors and SPs.
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General knowledge of The Joint Commission (TJC), the Department of Public Health (DPH), Department of Mental Health (DMH) and Centers for Medicare and Medicaid Services (CMS) rules, regulations, and standards.
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medicare medicaid jobs in Boston, MA
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