Top 20 companies that use CMS

2. Guidehouse

3. Prime Therapeutics

How Prime Therapeutics uses CMS:

• Experience in working with Content Management System (CMS) using Jelly Script and UI Macros.
• Assisted with completion of the CMS directed quality checks or price files prior to submission.
• Provided research and interpretation of CMS regulations to maintain database activity and operational support of Medicare D programs.

Most common skills for Prime Therapeutics:

• SAS
• Hippa
• End-To-End Testing
• Medicare
• HIPAA
• Outbound Calls

4. Highmark

How Highmark uses CMS:

• Processed enrollment applications for Medicare Plan D using CMS guidelines and Microsoft office.
• Supervised NCQA, CMS and Pennsylvania Department of Health compliance activities specific to quality improvement program structure and operations.
• Key role in provider contract compliance (CMS, DOL, COB Programs, SOX, etc.)

Most common skills for Highmark:

• Strong Analytical
• Customer Service
• Medicare
• PL/SQL
• Process Improvement
• Test Cases

5. Healogics

Most common skills for Healogics:

• Patients
• Ongoing Management
• UltiPro
• Data Warehouse
• Fixed Assets
• EMR

6. Humana

How Humana uses CMS:

• Research claims rejected by CMS and produce processes to prevent future claim denials.
• Processed TTR replies, and CMS errors, manually keyed new enrollments, familiar with CMS reply codes and transmit statuses.
• Maintain compliancy with all CMS and department standards.

Most common skills for Humana:

• CMS
• Medicare
• Customer Service
• Outbound Calls
• Medicaid
• HIPAA

7. Genesis Center

Most common skills for Genesis Center:

• EMR
• Patient Scheduling
• Therapeutic Interventions
• Vital Signs
• Substance Abuse
• Patients

8. Hawaii Pacific Health

Most common skills for Hawaii Pacific Health:

• Crisis Management
• HIPAA
• Radiology
• Clinical Documentation
• Patients
• Account Balances

9. Centene

How Centene uses CMS:

• Meet performance requirements including HHSC, CMS, Compliance and contractual agreements.
• Verify and process members appeals and grievances are processed and filed with CMS and state guidelines.
• Developed, implemented and oversaw operational performance measurements to support CMS guidelines, as well as financial and operational goals.

Most common skills for Centene:

• Medicaid
• CMS
• NCQA
• Process Improvement
• Quality Standards
• PowerPoint

10. DaVita Kidney Care

How DaVita Kidney Care uses CMS:

• Set clinic up for successful certification of CMS and state inspections.
• Maintained CMS, HIPPA, OSHA and Regulatory Compliance requirements.
• Complete all Care Planning/Notes to meet CMS guidelines.

Most common skills for DaVita Kidney Care:

• Patients
• CPR
• Patient Education
• CMS
• Catheter
• HIPAA

11. CVS Health

How CVS Health uses CMS:

• Participate in weekly fulfillment timeliness meetings to ensure compliance to CMS Guidance.
• Consult with Legal department for interpretation of CMS compliance regulations and vendor contract requirements.
• Supported TRR and MRR reconciliation with investigations and correction of enrollment transactions rejected by CMS due to correctable errors.

Most common skills for CVS Health:

• Customer Service
• Patients
• CVS
• Inventory Management
• HIPAA
• Computer System

12. Kaiser Permanente

How Kaiser Permanente uses CMS:

• Modified current or created new policies and procedures to optimize efficiencies and to maintain compliance relating to NCQA and CMS standards.
• Educated physicians and staff on correct coding initiatives through CMS conditions and updates.
• Formatted training updates and CMS documents for use with billing staff to assure the highest level of coding expertise.

Most common skills for Kaiser Permanente:

• Patients
• Customer Service
• Patient Care
• HIPAA
• Process Improvement
• HR

13. UnitedHealth Group

How UnitedHealth Group uses CMS:

• Remain compliant with Medicare and CMS accurately present disclosures amongst different states.
• Reviewed clinical for Home Health Authorizations and DME using Interqual, Milliman, and CMS guidelines.
• Maintained knowledge of benefits, networks, and CMS regulations to better inform and educate plan members and providers.

Most common skills for UnitedHealth Group:

• HIPAA
• Medicaid
• Elasticsearch
• Customer Service
• SAS
• Process Improvement

14. Oracle

Most common skills for Oracle:

• Java
• Cloud
• CRM
• UI
• ERP
• HTML

15. Prime Healthcare

How Prime Healthcare uses CMS:

• Work with department directors to improve patient satisfaction to meet CMS benchmarks.
• Chart abstraction for CMS core measures including concurrent chart review.
• Reviewed charts concurrently and retroactively to ensure compliance with CMS Care Measures.

Most common skills for Prime Healthcare:

• Medical Education
• CMS
• Group Therapy
• Peer Review
• Phone Interviews
• Legal Advice

16. Mission Regional Medical Center

Most common skills for Mission Regional Medical Center:

• Patients
• BLS
• Medical Terminology
• EKG
• Community Resources
• Meditech

17. Cigna

How Cigna uses CMS:

• Meet or exceed productivity and quality goals based on CMS guidelines/directives.
• Converted CMS systems from x25 to IP.
• Audited new hire and experienced claims processor associate claims, providing feedback and assuring claims were processed according to CMS guidelines.

Most common skills for Cigna:

• Customer Service
• SQL Server
• XML
• Process Improvement
• Healthcare
• Unix

18. AdventHealth

How AdventHealth uses CMS:

• Participate in Joint Commission, OHCQ and CMS surveys related to medical staff credentialing and privileging.

Most common skills for AdventHealth:

• HR
• Data Analysis
• Patients
• Project Management
• SQL Server
• Troubleshoot

19. Community Medical Services

Most common skills for Community Medical Services:

• Medical Services
• Medical Equipment
• Home Health
• Health Screenings
• Diagnostic Tests
• Medical Necessity

20. Dialysis Clinic

Most common skills for Dialysis Clinic:

• Patients
• Patient Accounts
• Water Treatment
• Patient Care
• Interdisciplinary
• Hemodialysis