now hiring experienced licensed psychologist or psychotherapist medicaid medicare full time or part time

CapitolHill Consortium for Counseling & Consultation LLC

<div>Now Hiring: Experienced Licensed Psychologist or Psychotherapist (Medicaid &amp; Medicare) &ndash; Full-Time or Part-Time
CapitolHill Consortium for Counseling &amp; Consultation LLC (CCCC)
Location: DC, Maryland, Virginia (In-Person or Hybrid)
Position Type: 1099 contract role with potential W-2 conversion contingent upon performance
Compensation: Competitive and commensurate with experience. 105,000 - 125,000/year
Join a thriving, mission-driven private group practice dedicated to accessible, high-quality, and culturally responsive care across the DMV region.
CapitolHill Consortium for Counseling &amp; Consultation LLC (CCCC) is seeking licensed clinicians with Medicaid and Medicare credentialing to join our well-established and growing multidisciplinary practice. We provide individual, couples, family, and group therapy, as well as psychological testing for clients across the lifespan&mdash;from children to elders. Services are offered both in-person and via telehealth, allowing for optimal flexibility and client reach.
Why Join CCCC?
Flexible Work Options
We offer part-time and full-time roles at one or more of our Washington, DC, Maryland, and Virginia offices&mdash;and/or hybrid. Build a caseload that suits your availability, professional goals, and lifestyle.
Administrative &amp; Billing Support
Our dedicated administrative team handles scheduling, billing, insurance, and credentialing so you can focus entirely on your clinical work. We also negotiate competitive reimbursement rates on your behalf and manage a robust referral and waitlist system to keep your schedule full.
Guaranteed Payroll
Enjoy the peace of mind that comes with reliable, accurate, and on-time payroll&mdash;every time.
Rich Clinical Community
CCCC provides a collegial, multicultural, and growth-oriented environment. Clinicians benefit from:
Weekly peer consultation groups
Supervision opportunities
Teaching and training roles for doctoral interns, externs, postdocs, and early career therapists
Career Growth Opportunities
In addition to therapy and testing, CCCC offers opportunities for:
Leadership and management pathways
Community engagement
Client workshops
Corporate and organizational consultation
Holistic retreats and wellness events
We believe in supporting your long-term vision for growth, innovation, and work-life balance.
Position Requirements
Candidates must be independently licensed in Washington D.C., Virginia or Maryland. Licensure in Washington, D.C. is preferred, with priority given to clinicians licensed across all jurisdictions
Must be able to be credentialed for Medicaid and Medicare
Passion for high-quality, compassionate mental health care
Commitment to ongoing professional development
Desired Experience 3-5 years
Must be local
Preferred Qualifications
Experience working with range of diverse clientele
Availability during after-school hours, evenings, or weekends
Willingness to work a hybrid schedule (some in-person availability preferred)
Benefits for Part Time 1099s
Full Service Administrative Support Including:
Dedicated Clinical Patient Care Coordinator (CPCC)
Dedicated Billing Specialists for Client and Insurance Collections
Credentialing Specialist
Office space as available and/or telehealth platform to practice
Clients, as available
Use of common space within the office
Routine supplies
Use of office equipment
Routine receptionist services
Routine appointment scheduling
Initial insurance authorization management
Contracting and liaison with insurance, public &amp; private organizations Filing and Electronic
Health Record assistance
Other usual and customary office supports
Bonus based on performance
Company parties
Competitive salary
Flexible schedule
Opportunity for advancement
Training &amp; development
Fixed pay rate
How to Apply
We welcome experienced and emerging clinicians who are seeking a supportive, inclusive, and values-aligned professional home. Apply now by submitting your CV and a brief cover letter.
CapitolHill Consortium for Counseling &amp; Consultation LLC is an equal opportunity employer. We strongly encourage applications from BIPOC, LGBTQIA+ clinicians, and those from historically underrepresented backgrounds.</div>

Now Hiring: Experienced Licensed Psychologist or Psychotherapist (Medicaid & Medicare) – Full-Time or Part-Time

<div>Now Hiring: Full-Time Experienced Independently Psychologist
CapitolHill Consortium for Counseling &amp; Consultation LLC (CCCC)
Location: DC, Maryland, Virginia (In-Person or Hybrid)
Position Type: 1099 contract role with potential W-2 conversion contingent upon performance
Compensation: Competitive and commensurate with experience. Ranged: 105,000 - 125,000/year
Join a thriving, mission-driven private group practice dedicated to accessible, high-quality, and culturally responsive care across the DMV region.
CapitolHill Consortium for Counseling &amp; Consultation LLC (CCCC) is seeking licensed clinicians to join our well-established and growing multidisciplinary practice. We provide individual, couples, family, and group therapy, as well as psychological testing for clients across the lifespan&mdash;from children to elders. Services are offered both in-person and via telehealth, allowing for optimal flexibility and client reach.
Why Join CCCC?
Flexible Work Options
We offer part-time and full-time roles at one or more of our Washington, DC, Maryland, and Virginia offices&mdash;and/or hybrid. Build a caseload that suits your availability, professional goals, and lifestyle.
Administrative &amp; Billing Support
Our dedicated administrative team handles scheduling, billing, insurance, and credentialing so you can focus entirely on your clinical work. We also negotiate competitive reimbursement rates on your behalf and manage a robust referral and waitlist system to keep your schedule full.
Guaranteed Payroll
Enjoy the peace of mind that comes with reliable, accurate, and on-time payroll&mdash;every time.
Rich Clinical Community
CCCC provides a collegial, multicultural, and growth-oriented environment. Clinicians benefit from:
Weekly peer consultation groups
Supervision opportunities
Teaching and training roles for doctoral interns, externs, postdocs, and early career therapists
Career Growth Opportunities
In addition to therapy and testing, CCCC offers opportunities for:
Leadership and management pathways
Community engagement
Client workshops
Corporate and organizational consultation
Holistic retreats and wellness events
We believe in supporting your long-term vision for growth, innovation, and work-life balance.
Position Requirements
Candidates must be independently licensed in Virginia or Maryland. Licensure in Washington, D.C. is preferred, with priority given to clinicians licensed across all jurisdictions.
Passion for high-quality, compassionate mental health care
Commitment to ongoing professional development
Desired Experience 3-5 Years
Must be local
Preferred Qualifications
Experience working with range of diverse clientele
Availability during after-school hours, evenings, or weekends
Willingness to work a hybrid schedule (some in-person availability preferred)
Benefits for 1099s 
 
Full Service Administrative Support Including: 
 
Dedicated Clinical Patient Care Coordinator (CPCC) 
 
Dedicated Billing Specialists for Client and Insurance Collections 
 
Credentialing Specialist 
 
Office space as available and/or telehealth platform to practice 
 
Clients, as available 
 
Use of common space within the office 
 
Routine supplies 
 
Use of office equipment 
 
Routine receptionist services 
 
Routine appointment scheduling 
 
Initial insurance authorization management 
 
Contracting and liaison with insurance, public &amp; private organizations Filing and Electronic Health Record assistance 
 
Other usual and customary office supports 
 
Bonus based on performance 
 
Company parties 
 
Competitive salary 
 
Flexible schedule 
 
Opportunity for advancement 
 
Training &amp; development 
 
Pay style Fixed
How to Apply 
 
We welcome experienced and emerging clinicians who are seeking a supportive, inclusive, and values-aligned professional home. Apply now by submitting your CV and a brief cover letter.
CapitolHill Consortium for Counseling &amp; Consultation LLC is an equal opportunity employer. We strongly encourage applications from BIPOC, LGBTQIA+ clinicians, and those from historically underrepresented backgrounds.</div>

Full-Time Licensed Psychologist Wanted (Hybrid Role)

Dane Street

<div>
 MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES.
 
 
 We are seeking an experienced CPC-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews, and provide litigation support including deposition and testimony services as needed. The ideal candidate must have experience reviewing medical records and billing across multiple states and payer environments.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
 </li>
 <li>
 Conduct utilization reviews to assess medical necessity and documentation compliance
 </li>
 <li>
 Review and prepare demand packages for personal injury and insurance cases
 </li>
 <li>
 Analyze medical records for payer disputes, recoupments, and appeals
 </li>
 <li>
 Prepare detailed, defensible written audit reports
 </li>
 <li>
 Provide expert review, affidavit support, deposition preparation, and testimony when required
 </li>
 <li>
 Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules
 </li>
 <li>
 Review E/M services under 2021+ guidelines
 </li>
 <li>
 Identify compliance risks and documentation deficiencies
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 Active CPC certification through the American Academy of Professional Coders (AAPC)
 </li>
 <li>
 CPMA strongly preferred
 </li>
 <li>
 Minimum 5&ndash;7 years of professional coding experience
 </li>
 <li>
 Documented experience performing audits or utilization reviews in multiple states
 </li>
 <li>
 Strong knowledge of CMS regulations and state Medicaid variations
 </li>
 <li>
 Experience with Medicare, Medicare Advantage, and commercial payer audits
 </li>
 <li>
 Prior demand package review or litigation support experience required
 </li>
 <li>
 Deposition and/or expert testimony history preferred
 </li>
 <li>
 Excellent written reporting and analytical skills
 </li>
 <li>
 Ability to work independently and meet strict deadlines
 
 
 </li>
 </ul>
 
 Preferred Experience
 
 
 
 <ul>
 <li>
 RAC, UPIC, or commercial payer audit response
 </li>
 <li>
 Multi-state Medicaid policy interpretation
 </li>
 <li>
 Expert witness experience in civil litigation
 </li>
 <li>
 Data analysis and audit trend reporting
 
 
 </li>
 </ul>
 This position may be structured as part time Candidates must be comfortable reviewing policies and payer rules across multiple jurisdictions and is able to do multiple types of reviews/audits
 
 
 
 Benefits
 
 
 
 Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
 
 
 
 About Dane Street
 
 
 
 A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers&rsquo; Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
</div>

General Coder - Must have experience doing bill audit reviews

AbbVie

<div>Company Description 
About AbbVie
AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas including immunology, oncology and neuroscience - and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on LinkedIn, Facebook, Instagram, X and YouTube. 
Job Description 
The Director, Government Affairs - U.S. Reimbursement, is responsible for monitoring and tracking reimbursement policy developments, developing comprehensive product coverage and reimbursement strategies for Medicare, and identifying Medicare Part B policy threats and opportunities that impact AbbVie&rsquo;s portfolio. The Director will represent AbbVie&rsquo;s interests before the Centers for Medicare &amp; Medicaid Services (CMS) and other relevant federal departments and agencies. As part of the U.S. Therapeutic Area Strategies (TAS) and Reimbursement team, the Director will also work in close collaboration with Government Affairs colleagues to develop comprehensive advocacy strategies to advance favorable public policies that are both aligned with enterprise goals and support product specific reimbursement strategies.
Responsibilities:<ul><li>
Grow and refine a deep understanding of the company&rsquo;s on-market products and pipeline assets, business strategies and channel-specific goals, and develop robust product-specific Medicare reimbursement strategies that aim to achieve optimal access.</li><li>
Develop educational resources and provide reimbursement guidance to inform launch planning and label changes for AbbVie products. Provide national reimbursement policy research related to Medicare to inform and support AbbVie commercial objectives.</li><li>
Establish, enhance, and maintain relationships with business leaders and garnering trust with cross functional partners as an expert and strategic advisor on the Medicare reimbursement process and CMS engagement, coupled with deep understanding of how it relates to the broader federal policy landscape. Lead the execution of Medicare reimbursement tactics and CMS engagement strategies, as appropriate.</li><li>
Work closely with the U.S. Policy &amp; Analytics team to track legislative and regulatory developments with a product-specific lens and align with Government Affairs colleagues to develop a position. Lead cross functional teams to develop and execute advocacy strategies to optimize, mitigate, or enhance policy changes related to Medicare Part B.</li></ul> 

Qualifications 
<ul><li>
Deep knowledge of the U.S. federal reimbursement environment with knowledge of the commercial payer market</li><li>
10+ years of experience in related role. Government Affairs experience preferred.</li><li>
Bachelor&rsquo;s degree in related field such as health care administration, political science, public administration, or public policy required. Advance degree preferred (MPH, MBA, JD, MPP).</li><li>
Expertise in coding, coverage, reimbursement, and Average Sales Price (ASP) methodology, with previous experience launching physician-administered drugs. Experience working on reimbursement issues in the oncology and neuroscience areas preferred.</li><li>
Knowledge of the Medicare and Medicaid programs, with a focus on Medicare Part A/B, the discarded drug refund policy, and the Inflation Reduction Act.</li><li>
Experience working with medical and provider societies on reimbursement and policy issues.</li><li>
Ability to identify reimbursement and policy opportunities and challenges, and to develop clear reimbursement related recommendations that take into account the broader political environment.</li><li>
Exceptional communicator (verbal, written, presentations). Ability to effectively communicate information and positions to internal and external stakeholders.</li><li>
Demonstrated success in working in a team environment and working in a collegial, yet highly demanding culture. Must be able to work collaboratively with business leaders and other internal stakeholders.</li><li>
Possess advanced analytical, critical thinking and interpersonal skills, the ability to speak and write persuasively and with clarity.</li><li>
Demonstrates advanced organizational skills with flexibility and adaptability to changing requirements. Is resourceful and creative with a strong attention to detail, a proven track record of being able to work under deadlines, and with an ability to work collaboratively in a fluid organizational environment.</li><li>
Domestic travel (25 percent) required.</li></ul> 

Additional Information 
Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law:
<ul><li>The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this postingbased on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more orless than the posted range. This range may be modified in the future.
</li><li>We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical/dental/vision insurance and 401(k) to eligible employees.
</li><li>This job is eligible to participate in our short-term incentive programs.
</li></ul>Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission,incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paidand may be modified at the Company&rsquo;s sole and absolute discretion, consistent with applicable law.<div></div>
AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives and serving our community. Equal Opportunity Employer/Veterans/Disabled.
US &amp; Puerto Rico only - to learn more, visit https://www.abbvie.com/join-us/equal-employment-opportunity-employer.html
US &amp; Puerto Rico applicants seeking a reasonable accommodation, click here to learn more:
https://www.abbvie.com/join-us/reasonable-accommodations.html</div>

Director, Government Affairs - U.S. Reimbursement

PHRMA

<div><h1 class="jobSectionHeader">Overview</h1>
Pharmaceutical Research and Manufacturers of America (PhRMA) is seeking a Director for its Policy and Research team to support policy and legislative/regulatory analysis related to drug pricing, including price-setting for medicines. The individual will be responsible for supporting PhRMA policy development and response to current and emerging technical issues related to drug pricing and price setting, including work shaping the implementation of the drug pricing provisions of the Inflation Reduction Act (IRA) and supporting defense against new price setting policies, such as foreign reference pricing. The Director&rsquo;s specific focus will include issues pertaining to pricing, coding and payment for physician administered medicines covered by Medicare Part B. The Director will also support work related to the Centers for Medicare and Medicaid Innovation (CMMI).<h1 class="jobSectionHeader">
The Director will:</h1><ul><li>
Provide supportive expertise on the Medicare Part B drug pricing provisions of the Inflation Reduction Act, including Medicare Drug Price Negotiation Program and Part B inflation rebates, and track and analyze their implementation by the Centers for Medicare &amp; Medicaid Services (CMS).</li><li>
Analyze proposals related to foreign reference pricing (also known as international reference pricing or most-favored-nation pricing) and other drug price setting mechanisms, and develop policy responses and advocacy materials in support of PhRMA&rsquo;s positions.</li><li>
Provide expertise on the Centers for Medicare and Medicaid Innovation (CMMI), including mandatory and voluntary payment and delivery models that affect drug pricing and coverage, and analyze their implications for pharmaceutical manufacturers.</li><li>
Analyze federal legislation, regulations, and other guidance related to drug pricing from CMS, the Department of Health and Human Services (HHS), and other relevant federal agencies, and guide the development of PhRMA comment letters through established work group processes and engaging outside consultants as necessary and appropriate.</li><li>
Analyze trends, research studies, and third-party policy analyses relating to drug pricing, price setting policy, and related healthcare payment and coverage issues.</li><li>
Lead the development of up-to-date proof points and materials in support of federal advocacy efforts on drug pricing, price setting, and CMMI-related issues. Analyze proposed legislation to identify key areas of interest for PhRMA members and coordinate with PhRMA&rsquo;s Law department and others on potential amendments and legislative alternatives.</li><li>
Prepare and deliver presentations on PhRMA&rsquo;s priorities to groups external and internal to PhRMA and lead the development of slide decks and other relevant materials.</li><li>
Support PhRMA&rsquo;s advocacy and third-party engagement with patient advocacy groups, provider organizations, and other stakeholders on drug pricing and price setting issues.</li><li>
Identify gaps in existing research and analysis and recommend action to fill the gaps, working in concert with the Policy and Research team. Manage day-to-day interactions with external consultants on assigned department-initiated projects.</li><li>
Perform other duties as assigned.</li></ul><h1 class="jobSectionHeader">
Key Success Factors</h1><div>
PhRMA seeks a collaborative team player who is passionate about access to medicines and contributing to the healthcare challenges we face today. Key success factors for this role include a high degree of organization and attention to detail, strong interpersonal skills, and the ability to consistently deliver high-quality work in a timely manner. The candidate will bring substantive health policy analysis experience, particularly regarding drug pricing and price setting policy, as well as exceptional written and verbal communication skills. The candidate should have demonstrated expertise in designing, reviewing, and interpreting in-depth policy analyses to support public policy advocacy and be able to work effectively across teams to advance shared goals.</div><h1 class="jobSectionHeader">
Professional Experience / Requirements</h1><ul><li>
Bachelor&rsquo;s Degree required.</li><li>
6+ years of experience in legislative or regulatory policy and/or advocacy.</li><li>
Strong writing that communicates clearly and persuasively on advocacy issues.</li><li>
Strong verbal communication and presentation skills.</li><li>
Ability to synthesize, distill, and clearly communicate complex ideas to a non-technical audience.</li><li>
Be an adaptable, creative problem solver who is comfortable working in a high-pressure environment.</li><li>
Excellent interpersonal skills that foster the ability to design and manage multiple projects simultaneously.</li></ul><h1 class="jobSectionHeader">
Preferred Experience / Requirements</h1><ul><li>
Prior experience working at CMS, HHS, or a drug manufacturer, health care trade association, or consultancy.</li><li>
A Master&rsquo;s degree in public policy or a related field.</li><li>
Experience developing and achieving public policy objectives in one or more of the following areas: Medicare drug pricing, the Inflation Reduction Act, CMMI payment and delivery models, foreign reference pricing, or related federal drug pricing policy.</li><li>
Familiarity with pharmaceutical market dynamics, including drug reimbursement, formulary design, and the roles of payers and pharmacy benefit managers (PBMs) in drug coverage and payment.</li></ul>
Potential Salary
$132,600 &ndash; $182,300 per annum. Salary is commensurate with experience and other compensable factors.
Who we are 
The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country&rsquo;s leading innovative biopharmaceutical research companies, which are laser focused on developing innovative medicines that transform lives and create a healthier world. Together, we are fighting for solutions to ensure patients can access and afford medicines that prevent, treat and cure disease. Over the last decade, PhRMA member companies have invested more than $850 billion in the search for new treatments and cures over the last decade, supporting nearly five million jobs in the United States.
Connect with PhRMA 
For information on how innovative medicines save lives, please visit: 
www.PhRMA.org 
www.Innovation.org 
www.MAT.org 
www.Facebook.com/PhRMA 
www.Twitter.com/PhRMA
What we offer 
In addition to a highly competitive salary and bonus program, various opportunities for reward and recognition and a platform of extensive benefits, PhRMA is committed to the development and overall wellbeing of our team members. We offer traditional (medical, dental, vision, flexible spending, life, AD&amp;D, LTD, STD) and enhanced benefits such as parental leave, a wellbeing program, back-up care, health advocate service, employee assistance program and commuting benefits. We also offer a robust 401k plan with employer contributions upon the first day of hire and immediate vesting, a generous paid time off plan, seven paid holidays (plus inauguration day), half day Fridays preceding holidays, half day Fridays in the summer months and a paid winter break. As an organization, we work in the office on Mondays through Thursdays and remotely on Fridays. We also all work remotely in August.
We are committed to the growth and development of our team members and offer many learning opportunities including an integrated on-boarding program, best-in-class leadership programming, tuition reimbursement, industry on-site and off-site training, and other management/professional development programs. Corporate social responsibility is also important to us at PhRMA. Our team members participate in organization-wide community service activities, fundraising drives and charitable athletic events.
We are committed to supporting our family of professionals at PhRMA and strive to create programs that help our team members manage the challenges of balancing a fast-paced career with their own personal goals.
Equal Opportunity Employer
PhRMA provides equal employment opportunities to all applicants without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, family responsibilities, genetic information, disability, matriculation, political affiliation or veteran status in accordance with applicable federal, state and local laws governing non-discrimination in employment.
The job description contains an overview of the activities and duties for this role. Responsibilities may change and new ones may be assigned at any time.</div>

Director — Policy & Research

CINQCARE

<div>Why Join Grace at Home?
Grace at Home is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient&rsquo;s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality&mdash;not a burden&mdash;every single day. Join us in creating a better way to care. 
Overview
The Manager of HEDIS, Stars &amp; ACO Data Analytics leads all aspects of HEDIS, Medicare Stars, and ACO quality measurement and reporting across product lines. This role ensures technical excellence, regulatory compliance, audit readiness, and timely submissions in accordance with the National Committee for Quality Assurance (NCQA), Centers for Medicare &amp; Medicaid Services (CMS), and the Executive Office of Health and Human Services (EOHHS).
The Manager drives quality performance improvement, optimizes pay-for-performance outcomes (e.g., Medicare Stars and Quality Withhold), oversees electronic clinical data integration, and works in a matrix environment with a multidisciplinary analytics team. This position significantly impacts regulatory standing, financial performance, and national quality ratings. 
Duties &amp; Responsibilities
<ul><li>HEDIS, Stars &amp; ACO Oversight<ul><li>
Establish and execute comprehensive operational work plans for HEDIS, Medicare Stars, and ACO quality performance.</li><li>
Lead the full HEDIS lifecycle: planning, data collection, validation, rate calculation, submission, and audit.</li><li>
Ensure compliance with NCQA, CMS, Medicaid, MMP (DSNP), and ACO requirements.</li><li>
Conduct performance analysis and root cause reviews to improve quality scores and financial incentives.</li><li>
Present results and performance insights to leadership and quality committees.</li></ul></li><li>
Data Strategy &amp; Integration<ul><li>
Lead initiatives to expand and optimize electronic clinical data exchange with provider EHRs, laboratory systems, and the State immunization registry.</li><li>
Improve data integrity, reporting accuracy, and operational efficiency.</li><li>
Identify and resolve data integrity issues in partnership with data governance and analytics teams.</li><li>
Partner with internal teams and external stakeholders to enhance data systems and quality outcomes.</li></ul></li><li>
Vendor &amp; Audit Management<ul><li>
Manage HEDIS software vendors and work with NCQA-certified auditors(s).</li><li>
Lead RFPs, contract oversight, and audit coordination.</li><li>
Monitor specification updates and ensure submission compliance.</li></ul></li><li>
Team Leadership<ul><li>
Lead, mentor, and develop cross-functional analytic and clinical staff.</li><li>
Ensure training, cross-training, and timely completion of all deliverables.</li><li>
Manage performance, accountability, and cross-functional team development.</li></ul></li><li>
Collaboration &amp; Strategy<ul><li>
Partner with Operations, Clinical, Network, Finance, Analytics, Practice Transformation, Care Management, Pharmacy, and Social Care.</li><li>
Support state and federal reporting requirements.</li><li>
Contribute to budgeting and strategic planning for quality analytics.</li></ul></li><li>
Compliance<ul><li>
Adhere to corporate compliance standards and regulatory requirements.</li></ul></li></ul>
Qualifications
<ul><li>Education: Bachelor&rsquo;s degree in health, informatics, data science, or related field required; Master&rsquo;s degree (MBA, MPH, MS, or related) preferred.</li><li>
Experience with Microsoft suite of tools (Excel, Word, PowerPoint, OneNote, Access etc.), PowerBI, and Tableau required; SAS, SQL, and other statistical tools preferred.</li><li>
5+ years in healthcare analytics; 5&ndash;10 years of HEDIS leadership experience.</li><li>
Experience leading HEDIS audits.</li><li>
Strong knowledge of HEDIS/QRS specifications, Medicare Stars measures, and healthcare data systems.</li><li>
Proven team leadership and project management experience.</li><li>
Strong analytical and communication skills.</li><li>
Vendor management and process implementation experience.</li></ul> 
The working environment and physical requirements of the job include:
Work is performed indoors in a setting with air conditioning and artificial light. Travel to and work in offices or other environments is required.
In this position you will need to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.
Travel may be required for team meetings on a quarterly basis or market visits as needed. 
Equal Opportunity &amp; Reasonable Accommodation Statement
Grace at Home is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law.
If you require reasonable accommodation during the application or employment process, please inform the recruiter during the hiring process.
Disclaimer
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.
Our Benefits
Financial Well-being<ul><li>
Competitive Compensation: We offer competitive salaries to attract and retain the best talent.</li><li>
401(k) with Employer Match: Plan for your future with our 401(k) plan and a generous 4% employer match.</li></ul>
Health and Wellness<ul><li>
Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.</li><li>
Dental &amp; Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.</li><li>
Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.</li><li>
Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.</li></ul>
Additional Perks<ul><li>
Continuing Medical Education (CME) Allowance for APPs: Stay at the forefront of your field with our CME allowance.</li><li>
Commuter Benefits: Save on your commute with our commuter benefits program.</li><li>
Mileage Reimbursement: Get reimbursed for work-related travel expenses.</li></ul></div>

Manager HEDIS, Stars, & ACO Data Analytics

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary
CVS Health/minute clinic is dedicated to helping people on their path to better health as part of the largest integrated pharmacy company in the United States. Through the company's more than 7,600 CVS/pharmacy stores; its leading pharmacy benefit manager serving more than 60 million plan members; and its retail health clinic system, the largest in the nation with more than 970 MinuteClinic locations, it is a market leader in mail order, retail and specialty pharmacy, retail clinics, and Medicare Part D Prescription Drug Plans. As a pharmacy innovation company with an unmatched breadth of capabilities, CVS Health continually strives to improve health and lower costs by developing new approaches. 
 
The Minute Clinic Accounts Receivable Associate, Senior Coordinator, will be responsible for:<ul><li>
Managing a high volume of medical claims that have denied by refuting the denials within payer guidelines through accurate review, correction, and resubmission</li><li>
Provide representation when needed of the Accounts Receivable area to internal dept.&rsquo;s as well as external dept.&rsquo;s, clients, vendors and processors to clearly relay situational occurrences and provide support when needed</li><li>
The account receivable associate will be responsible for identifying and quantifying trends/issues, developing potential solutions and then effectively communicate them to the appropriate members of the management team along with what the potential impact could be.</li><li>
Effectively prioritize and manage outstanding refund requests and overpayments to support contract and legal adherence with all payers including Medicare and Medicaid.</li><li>
Identify and implement process efficiencies across the dept. including automation opportunities or workflow enhancement opportunities to reduce manual efforts and improve productivity and overall compliance</li><li>
Recognize and Identify coding deficiencies and exercise the appropriate action based upon compliance and CMS regulations</li><li>
Identify key stake holders or primary contacts within payer communities to drive more effective processes</li></ul> 
Required Qualifications<ul><li>
The coordinator must have a clear understanding of the intricacies of medical billing encountered in such areas like ambulatory care, physician/provider offices, or professional billing settings.
</li><li>In addition, a clear understanding of CPT, ICD-9/10, CMS 1500 claim formatting, as well as, familiarity with Electronic Data Interchange (EDI) transmission, Electronic Health Record or encounter charge creation is key to success in this position.
</li><li>Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data is important.</li><li>
Minimum of 2 years of Medical Billing Experience or health plan claims adjudication experience</li></ul> 
Preferred Qualifications<ul><li>
3-5 Years of Medical Billing experience or health plan claims adjudication experience</li><li>
Technical Certificate in Medical Billing</li><li>
Microsoft Office with a focus on Excel, Outlook, and Word</li><li>
Time management skills</li><li>
The ability to multi-task</li><li>
Athena Practice Management experience
</li></ul>Education<ul><li>
Verifiable High School Diploma or GED required</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $42.35
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/31/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Minute Clinic Accounts Receivable Associate, Senior Coordinator, Revenue Cycle

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