Medicare and Medicaid Operations Manager
3 weeks ago
As a key member of the ProCare Rx team, the Government Programs Manager- Med Part D will oversee and support all Medicaid & Medicare Part D operational tasks in compliance with applicable federal, state and local laws, rules, regulations and internal policies and procedures.
Key Responsibilities- Serve as a subject matter expert in all CMS guidelines and processes for both government programs: Medicare & Medicaid.
- Support RFI and RFP submissions as well as pre-sales opportunities for Medicare Part D and Managed Medicaid clients.
- Collaborate in the development and optimization of operational workflows to integrate Medicare & Medicare requirements.
- Maintain oversight of all informative documents released by CMS and the claims processor, including memos, call letters, and regulatory guidance.
- Oversee the PDE full process in coordination with clients.
- Ensure compliance with CMS Reporting Requirements, including formulary submissions, pricing tools, pharmacy networks, EOB files, PDE, FIR, and data validation.
- Support operational areas during CMS auditing processes.
- Ensure processes are in place for claims processing, accurate timely and complete submissions to CMS, and compliance with CMS requirements.
- Provide support to EOB and FIR to report to clients jointly with IT and Operations Departments.
- Manage daily operations as they apply to clients in the U.S. mainland.
- Oversee the delivery of periodic reporting packages.
- Lead periodic meetings and conference calls with U.S. clients.
- Ensure cross-functional teams perform according to CMS guidelines, internal processes, and contractual agreements.
- Bachelor's Degree in Science, Business Administration, Health, or a related field.
- Minimum of three years of experience in Medicare/Medicaid Operations/Healthcare Industry.
- Fully Bilingual: English and Spanish language.
- Proficient knowledge of Windows, including Word, Excel, PowerPoint, and Access.
- In-depth understanding of laws, rules, and regulations related to healthcare corporate governance.
- Leadership
- Problem-solving, project management, technical, and monitoring skills
- Ability to write clear, concise reports, business correspondence, and develop policies and procedures
- Excellent communication skills to manage internal and external customers
- Judgment and criterion for decision making
- Detailed-oriented and presentation skills
- Ability to work in a fast-paced environment while demonstrating flexibility, commitment to teamwork, and a willingness to change assignments to meet clients' needs.
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Medicare and Medicaid Operations Manager
3 weeks ago
Gainesville, Florida, United States ProCare Rx Full timeJob SummaryWe are seeking a highly skilled Government Programs Manager- Med Part D to oversee and support all Medicaid & Medicare Part D operational tasks in compliance with applicable federal, state and local laws, rules, regulations and internal policies and procedures.Key ResponsibilitiesOversee and support all Medicaid & Medicare Part D operational tasks...
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Reimbursement Director
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Gainesville, Florida, United States Northeast Georgia Health System Full timeJob SummaryUnder the general direction of the Executive Director, Corporate Controller, the Reimbursement Director is responsible for coordinating all CMS reporting requirements, including oversight of GME reporting functions. Additionally, this role involves the administration of the charge description master and revenue forecasting for both budget and...
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RN Care Coordinator
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Medical Collections Specialist
4 weeks ago
Gainesville, Florida, United States Select Source International Full timeJob DescriptionJob Title: Medical Collections SpecialistLocation: Remote opportunity with a 100% on-site requirementContract: 6-month contract with possible extensionNature of Work:Focused on collections of patient accounts using LVAD, filing claims, reviewing EOBs from insurance companies, and communicating with patients over the phone.Utilize proper codes...
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Medical Billing Specialist
3 weeks ago
Gainesville, Florida, United States Experis Full timeWe are seeking a skilled Medical Billing Specialist to join our team at Experis. This is an exciting opportunity to work with a leading Medical Device & Healthcare organization in the Orlando, FL area.Job Details:Job Title: Customer Accounts Specialist/ Medical BillingContract Duration: 5+ Month (Temp to Perm)Location: Gainesville, FLPay Range: $17.70/hour...
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Operations Manager
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Operations Manager
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Operations Manager
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Territory Operations Manager
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Service Operations Manager
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Restaurant Operations Manager
4 weeks ago
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Agricultural Operations Manager
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Restaurant Operations Manager
4 weeks ago
Gainesville, Florida, United States Checkers Drive-In Restaurants , Inc. Full timePurpose of Your WorkAs a Shift Manager at Checkers & Rally's, you will play a vital role in assisting the General Manager in managing successful shifts, achieving sales and profit goals, and providing excellent Guest and Team service. Your responsibilities will include building sales and profits by promoting Guest satisfaction and managing restaurant...
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Agricultural Operations Manager
3 weeks ago
Gainesville, Florida, United States InsideHigherEd Full timeAgricultural Operations ManagerThis position is responsible for overseeing the daily operations of the Agronomy Forage Research Unit and the Beef Research Unit. The successful candidate will have a strong background in agronomy and experience in managing agricultural operations. The position will involve supervising graduate students and OPS employees,...
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Warehouse Operations Manager
3 weeks ago
Gainesville, Florida, United States Ascend Advanced Therapies Full timeJob DescriptionAscend Advanced Therapies is seeking a highly skilled and motivated Warehouse Operations Manager to lead the warehouse operations team. The successful candidate will be responsible for ensuring safe, GMP compliant execution and management of operations to support GMP manufacturing.Main Responsibilities:Develop and implement the overall...
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Restaurant Operations Manager
4 weeks ago
Gainesville, Florida, United States Wahoo Seafood Grill Inc Full timeJob Title: Restaurant Operations ManagerWahoo Seafood Grill Inc is seeking a highly skilled Restaurant Operations Manager to join our team. As a key member of our management team, you will be responsible for ensuring the smooth operation of our restaurant, maintaining high quality standards, and providing exceptional customer service.Key...
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Restaurant Operations Manager
4 weeks ago
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Restaurant Operations Manager
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Pharmacy Operations Manager
4 weeks ago
Gainesville, Florida, United States Walgreens Full timeJob SummaryWe are seeking a highly skilled Pharmacy Operations Manager to join our team at Walgreens. As a key member of our pharmacy team, you will be responsible for overseeing the day-to-day operations of our pharmacy, ensuring efficient workflow and a positive patient experience.Key ResponsibilitiesManage and supervise pharmacy technicians and cashiers...
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Restaurant Operations Manager
3 weeks ago
Gainesville, Florida, United States CheckersRally's Full timeKey Responsibilities:As a Shift Manager at Checkers & Rally's, you will be responsible for managing successful shifts, achieving sales and profits goals, executing procedures, and providing excellent Guest and Team service. You will support the restaurant and General Manager to ensure we are 1st Choice for our Guests and Employees.Key Performance...