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Serving millions of Medicare and Medicaid patients, Optum is the nation’s largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family. For NPs: Graduate of an accredited master’s degree in Nursing (MSN) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP.
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Oversee accounts receivable collections for past due patient accounts; facilitates timely filing of Medicare, Medicaid, and insurance claims. These functions are revenue cycle management, billing and accounts receivable, census processing, payroll, accounts payable, and patient/resident trusts.
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Uses Market Access technical expertise (i.e., coding, reimbursement and payer policies related to Medicare, Medicare Part D, Medicaid, and private insurance) to educate matrix partners , field teams, PMs, and Senior PMs.
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In-depth knowledge of Medicaid, Medicare, and Managed Care fee for service (FFS) billing and reimbursement. Knowledge of Electronic File transmittals/remits with Medicaid/Medicare EDI departments.
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Has strong knowledge of the individual and senior market segments including individual plans, Medicare Supplements, Medicare Advantage, and Part D programs. Amerigroup is a proud member of Anthem's family of brands, offering Medicaid and Medicare plans in several states.
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Medicare Senior Program Director. Reports to VP or AVP in the Client Engagement, Specialty Operations, or Market Segment Services, Government Programs, Operations, Planning & Delivery, Finance, or Stars & Quality departments.
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This organization is a Medicare Advantage Institutional Special Needs Health Plan (ISNP) for long-term nursing home residents. The plan covers all medically necessary and preventive services covered under Medicare Parts A, B, and D. They are strongly focused on improving their members' physical, mental, and social well-being through personalized clinical care and therapies.
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Experience with Medicaid Advantage Plus (MAP) and Medicare Advantage (FIDE) Dual Special Needs Plans. 6+ years experience in one or more of the following at a managed care or provider organization: DSNP programs, Managed Care Operations, Medicare Advantage.
$79,200 - $170,800 a yearFull-timeExpandUpdated 2 days ago - UpvoteDownvoteShare Job
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Preferred Board Certification or Eligibility in an ABMS or AOA recognized specialty Active and unrestricted medical license Unrestricted DEA license and dispensing license for state of jurisdiction (required prior to start date) Must be eligible to participate in Medicare FMCSA NRCME certification preferred or willingness to obtain.
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Knowledge of Medicare Advantage, and experience leading an operational unit. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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Provider Growth Consultant – Medicare Sales page is loaded. Provider Growth Consultant – Medicare Sales. Leads large scale, cross-functional provider growth initiatives that are intended to Medicare membership growth.
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Associate Director, Data Management - Managed Markets - Customer Engagement & Digital Transformation
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This individual will provide data management support to help the organization lead the evolving and changing market access & reimbursement environment across Commercial, Medicare and Medicaid channels, supporting Rx, sales, formulary, and industry insights from Managed Markets (Payers, MCOs, PBMs, Employer Groups, IDNs, Medicare, Medicaid) and other Managed care organizations.
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Expertise of Prescription Benefit Manager (PBM) services in relationship to Medicare Part D within Long-Term Care Pharmacies/Facilities preferred. We are looking for an amazing executive with leadership experience and expertise of Prescription Benefit Manager (PBM) services in relation to Medicare Part D within Long Term Care/Pharmacies.
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Oversees vendor delivery to our Medicare Advantage and Exchange customers, including contract management, strategy development, operational delivery and invoicing. Engages with external resources, including the consultant community, in order to evaluate and understand the current and emerging market for Medicare Advantage and Exchange programs.
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Associate Director, Data Management - Managed Markets - Customer Engagement & Digital Transformation
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Janssen Pharmaceuticals, Inc. provides medicines for an array of health concerns in several therapeutic areas, including Immunology, Oncology, Cardiovascular & Metabolism, Neuroscience and PAH. Knowledge of existing and emerging data sources and data vendors in Pharma Commercial domain, including IMS/IQVIA, SHS, MMIT formulary, SPP, patient claims, RWE/HEOR, etc.
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medicare job in Lawrence, NJ
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