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The OCE serves the Court of Appeals as well as all of the District Courts, Bankruptcy Courts, Probation and Pretrial Services Offices, and Federal Public Defender's Offices within the Ninth Circuit.
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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
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Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. May also engage in grievance and appeals reviews.
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Specific responsibilities include the management of records and hands-on, detailed casework associated with the Provost's decision-making role in employee and student (where applicable) appeals of Office of Compliance findings, Academic Staff Appeals Committee (ASAC) appeals and grievance recommendations, Hostile and Intimidating Behavior (HIB) appeals of findings, all Faculty Policies and Procedures Chapter 8 and 9 matters, and research misconduct matters that come before the Provost.
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Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization + Advanced degree such as an MBA, MHA, or MPH + Exposure to Public Health principles, Population Health, analytics, and use of business metrics.
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Medical Director - Southeast Region - Work from Home at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims.
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The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
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The clinical scenarios predominantly arise from inpatient or post-acute care environments. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
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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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Preferred Qualifications + 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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The Court of Appeals, Office of the Clerk is seeking a motivated individual to join their team as a Document Imaging Specialist. Checks C-Track to ensure that Appeals Specialist assigned to the case is correctly identified before scanning document.
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Experience in Medicare Advantage Claims, Appeals & Grievances, program/project management. The Program Manager leads and manages key operational programs, initiatives and strategic projects that span across the functional teams of Claims, Configuration and Appeals and Grievances.
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As certified by the state of Virginia (VDHCD) and/or appointed by the relevant Code Official to do so on their behalf, the Code Compliance Investigator II conducts research; field investigations; interviews with residents/community; gathers evidence; and applies a variety of investigative techniques regarding alleged code violations - to include preparation of material for testimony in court and/or other adjudicative bodies (e.g. Board of Zoning Appeals; Local Board of Building Code Appeals.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. The curiosity to learn, the flexibility to adapt and the courage to innovate Additional Information Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business.
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Knowledge of all payors insurance; self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third party billing, required. Manage claim details and verify accurate reimbursement, so as to initiate account adjustments and/or appeals on payment disputes.
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