Provide project management and subject matter expertise to help Medicaid agencies design, develop, and implement waiver and state plan amendments.
Build relationships and communicate project status with client contacts, stakeholders, federal partners, and vendor contacts.
Oversee and mentor junior staff while participating in business development activities like writing blog posts and reviewing RFPs.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies. It is a client-centered, people-first firm recognized for its diverse, inclusive culture and focus on learning, development, and well-being.
Lead prospective claim review audits related to clinical DRG coding compliance and readmissions programs.
Act as Subject Matter Expert to counsel other team members across Clover on clinical coding guidelines.
Collaborate with teams across Clover to ensure provider understanding of Payment Integrity recommendations.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most; they are passionate and mission-driven individuals.
Design, implement, and oversee a comprehensive compliance program aligned with OIG and state Medicaid requirements.
Serve as the primary HIPAA Privacy Officer, managing policies, training, and breach response protocols.
Conduct internal audits, manage the compliance hotline, and report risk findings to executive leadership.
AbriCare provides personal home care and nursing services, ensuring adherence to healthcare regulations and delivering compassionate care. The organization fosters a culture of integrity and accountability, partnering with clinical and operational leadership to maintain high standards.
Lead end-to-end audits of provider charge masters and billing practices.
Design and enhance audit frameworks, models, and dashboards.
Evaluate audit findings to determine materiality and recommend resolutions.
Capital Blue Cross is committed to going the extra mile for their team and community. Employees have consistently voted it one of the "Best Places to Work in PA", reflecting a culture that values its employees.
Own and manage shared inboxes and ensure timely review, triage, escalation and routing of requests
Identify trends, risks, or recurring issues and ensure escalation and action planning
Conduct compliance audits, write corrective action plans and work with department managers to ensure timely completion and compliance with local, state and regulatory requirements
Centene is transforming the health of communities, one person at a time. As a diversified, national organization, they offer competitive benefits and a fresh perspective on workplace flexibility.
Identifies, documents, and evaluates business risks, recommending improvements.
Prepares detailed audit reports for executive management, conveying evaluations and recommendations.
BlueCross BlueShield of South Carolina is a leading health insurance company and administrator of government contracts. They have been in business for over seven decades with strong roots in the South Carolina community and an A+ (Superior) A.M. Best rating.
Execute end-to-end testing and validation of pharmacy benefit plan configurations.
Perform detailed implementation audits to ensure benefit setup aligns with client intent and regulations.
Analyze claim outputs to confirm expected adjudication behavior and accumulator movement.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have full-service pharmacy benefit management (PBM) solutions to self-insured employers.
Enrolling practitioners in health plans in a timely and effective fashion.
Monitoring progress and ensuring timeliness of enrollment completion.
Maintaining provider enrollment goals for all divisions.
Pediatrix Medical Group provides specialized health care for women, babies, and children. Since 1979, Pediatrix has grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services.
Provide reporting of claims on behalf of brokerage clients
Communicate with carrier adjusters and clients to facilitate successful handling and resolution of claims
Act as claims liaison, including consultative discussions and research regarding coverages
Signers National is a leading insurance platform that provides brokerage and underwriting services to organizations of all sizes. They started in 2008 and have expanded to include commercial real estate and transportation and strive to positively affect people's lives with their amazing culture.