Review Medicaid and CHIP eligibility determinations for compliance with federal and state regulations.
Prepare audit reports and documentation for program stakeholders.
Collaborate with state agencies to resolve questions and clarify eligibility procedures.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It uses technology to review applications and share top-fitting candidates directly with employers.
Lead portions of regulatory assessments, external audits, and accreditation processes for Commercial, Medicare, Medicaid, and Marketplace departments.
Act as primary point of contact for internal and external partners on regulatory activity, quality efforts, SOP development, and client delegation agreements.
Maintain regulatory gap status reporting, track work streams, and lead change management related to regulatory requirements.
Prime Therapeutics is a pharmacy benefit manager (PBM) with a purpose beyond profits, reimagining pharmacy solutions to connect care for those they serve. The company is a large, purpose-driven organization focused on simplifying healthcare and fostering a collaborative culture.
Enroll practitioners in health plans accurately and timely, monitoring progress and ensuring completion.
Validate and maintain provider enrollment forms, applications, and tracking systems.
Communicate with internal teams to meet enrollment goals and target start dates.
Pediatrix Medical Group is one of the nation's largest providers of prenatal, neonatal and pediatric services. With a focus on team approach, the company is home to a diverse group of business professionals dedicated to improving patient lives.
Prepare and submit provider enrollment applications and gather supporting documentation.
Track application status, follow up with payers, and resolve enrollment discrepancies.
Maintain accurate provider records in internal systems and coordinate with billing and credentialing teams.
We are a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. Our team is fully remote and we value collaboration and attention to detail.
Review and analyze Medicare claims sampled by the Department of Justice to determine correct coding and payment based on coverage and utilization.
Conduct in-depth claims analysis to detect fraudulent or abusive billing practices using ICD-10, CPT-4, and CMS guidelines.
Complete summary reports and communicate findings internally while maintaining confidentiality and compliance with DOJ and CMS regulations.
Empower AI provides AI-powered solutions for federal government agencies, helping them transform their workforce and operations. Headquartered in Reston, Va., the company has three decades of experience in Health, Defense, and Civilian missions and is recognized as a 2024 Military Friendly Employer.