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The CMO Group Medicare will be an integral part of the GM Leadership team and will be responsible to lead and provide thought leadership internally and externally on behalf of Group Medicare.
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Experience in health care, health plans, Covered California, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect.
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Avosys is seeking a Bexar County Remote Registered Nurse - Medical Review Specialist to work remotely to review Medicare claims. Utilize the applicable Medicare policies (i.e., Local Coverage Determinations, National Coverage Determinations, Internet-Only Manual (IOM) citations, inpatient tools, etc.
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Responsible for providing medical direction to and adhering to requirements, terms, and conditions required by Medicare Conditions of Participation (COP), accrediting bodies, federal and state statutes that govern the provision of services.
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With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years.
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Riverview is also the areas highest rated hospital, receiving Four-Stars from the Centers for Medicare and Medicaid (CMS). Now Hiring full time day shift CNA's for our Medical Surgical 4th Tower Unit. The CNA in the Med Surgical department is a certified assistive person who assists with activities of daily living, provides basic nursing care to non-critical patients and assists in maintenance of a safe environment under the direction and supervision of the Registered Nurse in charge of the team and/or unit.
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Advocacy - Leading voice with Administration officials to improve federal rules and regulations affecting Medicare, Medicaid, Duals, and CHIP. Work in close partnership with lobbying team to support congressional education and engagement, including federal lobbying activities on Capitol Hill, as well as with state officials focused on Medicaid solutions.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus. PSS Field Reimbursement Manager- Bakersfield (Remote) | Novartis.
RemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Your primary objective will be to assess the overall health and well-being of Medicare beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care.
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Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems. As a Landmark Health Provider, now a part of the Optum family, you visit your panel of patients in the comfort of their own homes.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and/or Affordable Care Act (ACA) using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, and Centers for Medicare and Medicaid Services (CMS) coding guidelines.
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Sage Health builds enriching neighborhood health centers that are easy to access, provide or arrange for all of our patients' healthcare needs, and partner with Medicare Advantage plans that fully cover primary care.
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Demonstrates confidence and knowledge of Medicaid and Medicare billing processes and systems. Works closely with Medicaid and Medicare representative to ensure that all payments and allowances are accurate.
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The reimbursement analyst will maintain current knowledge of Medicare, Medicaid and other State and Federal regulations. Analyze and complete Medicare, Medicaid, Tricare and Blue Cross cost reports, settlements, audits and appeals and maintain all documentation.
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What qualifications you will need:Graduate of an accredited school of professional nursingMinimum of one or more years of home health, public nursing or acute hospital nursing experienceFamiliar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly preferred)Reliable transportation and proof of valid automobile liability insuranceMust have valid driver’s licenseCurrent BCLS Certification prior to providing patient care.
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