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May also engage in grievance and appeals reviews. Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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Become a part of our caring community and help us put health first. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
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Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists. Advanced degree such as an MBA, MHA, MPH. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
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Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. Experience with national guidelines such as MCG.
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Exposure to Public Health, Population Health, analytics, and use of business metrics. 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age.
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The CMO will also maintain accountability for the oversight of the Health Services division, including Pharmacy, Utilization Management, Care and Disease Management, Quality Improvement, Appeals & Grievances, Medical Policy and Provider Engagement and Clinical Transformation.
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CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years.
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The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities.
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Collaborate with the Executive Director and Manager of Development & Fundraising to identify foundation funding opportunities, prepare grant proposals, and participate in appeals to donors. ● Conduct legal research regarding relevant legal topics as needed, such as in the areas of employment law, disability-related law, contract, lease, and intellectual property, as well as regarding a wide variety of compliance issues, ranging from New York City building code regulations to Medicaid and HIPAA.
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Maintain accurate records and documentation of all Medicaid billing activities, including claim submissions, payments, and appeals. 5 years of experience working in medical billing or revenue cycle management, with a focus on Medicaid billing and reimbursement.
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Person MUST come with 1 year of experience and knowledge in Veteran Affairs, Worker Compensation, Medicaid, Medicare Advantage, PPO and Prior Authorization Appeals. Volt is immediately hiring a Benefits Specialist in Orlando, FL As a Benefits Specialist , you will: Person will be doing Verification of Benefits in the Appeals process for prior authorization / denials / exceptions, etc.
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Assists Coding Supervisor with the appeals process for DRG changes/denials. Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles and methodologies and must have a working knowledge of the compliance guidelines related to coding and billing.
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Knowledge of Medicare and Medicaid billing guidelines and regulations. The Billing & Accounting Specialist will be responsible for accurately processing billing documentation, handling claims, ensuring compliance with Medicare and Medicaid regulations, and assisting with accounting related tasks.
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Virtual Reality Job Interviews
With the advent of desktop computers, the arduous task of scouring through weekly job classifieds became a thing of the past. The mid-1990s brought about a new era where job seekers could easily search and apply for jobs online. The introduction of AOL's Instant Messaging feature provided an even faster means for employers and candidates to communicate and schedule interviews. As smartphones became more pervasive in the early 2000s, hiring managers increasingly used phone calls for screening and interviewing candidates. Despite this trend, over 80% of interviews still took place in person.
A Potential TikTok Ban?!
As you may already know, there has been a lot of talk lately about the possibility of a TikTok ban. While this has not yet come to fruition, it's important to consider the implications this could have for businesses and recruiters who rely on TikTok as a platform to market their brand, recruit new talent, and connect with their audience.
The Effects of Workplace Racism and Sexism
One day it's a covert statement to a mother returning to work after maternity leave. Another day it's a lingering gaze at an employee enjoying a culturally rich meal. These microaggressions (or sometimes macroaggressions) can take an employee from a confident, high-performer to one that feels insecure being themselves at work. Your employees engage with people with different ideas and feel most comfortable and valued when they can work without losing their cultural, racial, and gender identity. While most employers know this, why have workplace racism and sexism often been neglected?
When Rage Applying Strikes: How to Identify Unserious Candidates
As the job market remains highly competitive, we have seen a surge in "rage applying." This is when candidates apply to multiple jobs, often without considering whether they are truly interested in the role. Rage applying goes hand-in-hand with quiet quitting. Often, employees want to entertain the thoughts and feelings of leaving their job, but they aren't necessarily serious about leaving yet. Meanwhile, other employees engaging in this trend are actually trying to find a better role. As a recruiter, it can be hard to identify who are the real applicants in a sea full of quiet quitters, but understanding rage applying and identifying red flags will certainly help.
How to Increase Job Ad Exposure
In today's competitive job market, writing quality job ads is critical for attracting top talent to your organization. While networking and candidate referrals are prime real estate for finding qualified candidates, nothing beats the tried-and-true method of writing an extraordinary job ad. But while writing a great job ad is the first step, what's more important is increasing visibility. You could have the most detailed, well-written ad on the internet, but if no one sees it, then you are wasting time (and potentially money!). Employers often believe that job boards are the root of the problem, but you can learn how to increase job ad exposure by tweaking a few steps of your recruitment process.
How to Navigate Hiring Out of State
The job market has shifted significantly in recent years. The accelerated adoption of technology has not only pushed many companies into remote working arrangements but also increased the availability of supporting tools and technologies (i.e., video conferencing and collaboration software).
Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.