with CMS and interoperability mandates. The ideal candidate possesses deep knowledge of Smile CDR architecture, FHIR standards... initiatives. Support CMS, ONC, Prior Authorization, Patient Access, Provider Access, Payer-to-Payer, and BCBSA Interoperability...
: Strong command of CMS regulatory frameworks and seasonal enrollment cycles including AEP (Annual Enrollment Period) and OEP... and Senior Health Insurance industry expertise is strongly preferred. Deep familiarity with carrier ecosystems CMS regulatory...
& Medicaid Services (CMS) reviewing the prior authorization (PA) and step therapy (ST) criteria that Medicare Part D plan... sponsors submit for approval. Pharmacist Reviewers evaluate sponsor criteria against CMS guidance in Chapter 6 of the Medicare...
, and university CMS, CS Link, and EAB systems. Ability to communicate with an ethnically and culturally diverse campus community...
language, in English and Spanish. Make sure all beneficiary-facing materials follow CMS GUIDE Model marketing...
, and university CMS, CS Link, and EAB systems. Ability to communicate with an ethnically and culturally diverse campus community...
of applicable CMS/PACE guidelines and organizational policies;ensure timely completion and documentation of UAS-NY. Remain...
with internal policies, Center for Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable... requirements. Meets or exceeds Federal service level requirements for a Medicare Managed Care call center monitored by CMS...
information and order records. Update transactions and relevant information in CMS TRAX. Assist with invoicing, payment records...
in the Northeast—and one of just 19 nationwide—to have earned five-star CMS ratings for both Overall Hospital Quality...