- Serco (Washington, DC)
- …processing systems (including MMIS), payment policy, payment systems, coding, billing, and compliance rules in Medicaid and CHIP. + Extensive knowledge and ... processing systems (including MMIS), payment policy, payment systems, coding, billing, and compliance rules in Medicaid and CHIP; + Extensive experience in… more
- Serco (Washington, DC)
- …policies, business process; operations and contract deliverables, for estimating Medicaid and CHIP eligibility error rate and improper payments. + Oversee ... of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as… more
- Serco (Washington, DC)
- …and third- party liability; + Knowledge of payment systems and coding, billing and compliance rules; and + Knowledge of the Medicaid and/or CHIP program, ... of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as… more
- Serco (Washington, DC)
- …program management experience; + Knowledge of payment systems and coding, billing and compliance rules; + Knowledge of the Medicaid and/or CHIP program, ... claims processing systems and processes.The position advises on the business and operational processes to ensure the full optimal...Knowledge of state payment systems and coding, billing and compliance rules, preferably on Medicaid and/or CHIP… more
- Huntington Ingalls Industries (Woodlawn, MD)
- …HI This opportunity resides with Command, Control, Communications, Computers, Cyber, Intelligence , Surveillance and Reconnaissance (C5ISR), a business group ... the sensors, systems and other assets necessary to support integrated intelligence , surveillance and reconnaissance (ISR) operations, exploitation and analysis for… more
- Commonwealth Care Alliance (Boston, MA)
- …and extracts into format usable in analytical database + Works collaboratively with Business Intelligence unit and fellow Compliance team members to ... the FDR program, as well as responsibility for first-level Compliance review in onboarding of new business ...contacts due to needs of the program, Medicare, or Medicaid . + Coordinates, with the Compliance Manager,… more
- Commonwealth Care Alliance (Boston, MA)
- …to ensure compliance . + Works closely with the Governance, Risk & Compliance (GRC) teams (Medicare, Medicaid , Privacy, Fraud, Waste & Abuse) for ... vendor management, health insurance government products and programs (Medicare, Duals/SNP, Medicaid , LTSS), and/or compliance experience required, on the… more
- Humana (Columbus, OH)
- …implement regulatory compliance policies and procedures + Research regulatory compliance issues and make business recommendations that assure compliance ... needed + Provide compliance guidance, direction, and compliance risk assessment to assigned business partners...on process and quality + High level of emotional intelligence + Ability to work independently and utilize excellent… more
- HealthEdge Software Inc (Columbus, OH)
- …upstream, and all aspects of claims operations are centralized for comprehensive business intelligence . The complete suite of solutions fromHealthEdgedelivers a ... **Overview** **Overview:** The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting… more
- Serco (Washington, DC)
- …+ Oversee performance of the eligibility, medical and claims reviews for estimating Medicaid and CHIP improper payments - including business processes, staffing, ... of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as… more
- General Dynamics Information Technology (MD)
- …Waste and Abuse (FWA) analytics, collaborating with FWA Subject Matter Experts and Business Intelligence Developers to develop to develop FWA models and ... of Data Scientists, embedded within a multi-disciplinary organization of Data Scientists, Business Intelligence Analysts and FWA Subject Matter Experts. Our team… more
- Serco (Washington, DC)
- …of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as ... medical reviews, data processing reviews, and eligibility reviews of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting… more
- EssilorLuxottica (Mason, OH)
- …and layout, procedural standards and operational efficiency + Partners with the Business Intelligence team when new or modified reports require consultation ... Senior Analyst - Business Data (Reporting Design) Date: May 14, 2024...a managed care setting + Experience with Medicare and/or Medicaid programs and reporting + Experience with health provider… more
- Serco (Washington, DC)
- …of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as ... eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting… more
- Commonwealth Care Alliance (Boston, MA)
- …a vision and strategy for Internal Audit, internal controls, and Sarbanes-Oxley (SOX) compliance in alignment with CCA's priorities and business objectives while ... plan and activities, and that supports and facilitates organizational strategy, business objectives, and effective financial, operational, compliance and… more
- Highmark Health (Pittsburgh, PA)
- …activities essential to Government Market Growth in support of Medicaid membership and margin goals. Strategy Partners provide analytical/strategic-thinking and ... Highmark, (2) prioritize potential opportunities and (4) support development of business cases to facilitate decision to move forward with opportunities. Strategy… more
- Serco (Washington, DC)
- …of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as ... medical reviews, data processing reviews, and eligibility reviews of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting… more
- Serco (Washington, DC)
- …of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as ... medical reviews, data processing reviews, and eligibility reviews of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting… more
- Universal Health Services (Reno, NV)
- …the Product Development Director will provide essential support to the organizational business teams in the development, implementation, and compliance of new ... Development + Strategic Product Design + Product Insights and Market Intelligence + CMS/Regulatory Programming + SNP Programming + Regulatory Submissions… more
- Spokane County (Spokane, WA)
- …applications, department medical applications, operational reporting, data warehousing, and business intelligence environments, including vendor management of ... ongoing maintenance of technical documentation associated with the data warehouse and business intelligence systems. + Supervises and provides oversight for the… more