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Key Competencies include:Foundational Thinking Skills: Review inpatient medical records for identified payer populations (Medicare, Medicaid, Blue Cross/Blue Shield, and others) as directed on admission and throughout hospitalization.
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The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
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Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston.
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Subject matter expert on the acute side of case management; experience with health plans: Medicare, Anthem, Blue Shield/Blue Cross, Cigna, etc. Each day will start with a huddle to level set the day, and comprised of approving discharge planning tools, DME, planning transportation, answering phone calls, denials, issuing Medicare notice, and available and ready to help the team whenever it is needed.
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New Care Center scheduled to open 12/4/2023 Peoria/Deer Valley locationAbout Prosano Health Solutions:Prosano Health Solutions, in partnership with Blue Cross Blue Shield of Arizona, is launching an Advanced Primary Care model, exclusive to Blue Cross and Blue Shield Members, available thru Employers who offer the BlueSignature benefit to their team members.
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Fill out provider applications for contracted payers-Blue Cross products, Blue Shield products, Medicare, Medicaid, Tricare, ACN, etc. MINISTRY/FACILITY INFORMATION Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities.
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Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums.
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Choice of Blue Cross Blue Shield Medical, Dental and Vision Plans. Oversees vendor delivery to our Medicare Advantage and Exchange customers, including contract management, strategy development, operational delivery and invoicing.
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Submission of medical claims to insurance companies and payers including Medicare, Medicaid, Blue Cross/Blue Shield, and commercial insurances. Direct hire opportunity with access to benefits including health/dental/vision, PTO, a pension plan, life insurance, employee wellness program, and more.
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Elite Low Cost Gold Plan Blue Cross Blue Shield Health Insurance. Healthcare billing and collection experience with nursing home receivable which includes Medicaid and Medicare Part A & B, HMO's preferred.
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Engages with external resources, including the consultant community, in order to evaluate and understand the current and emerging market for Medicare Advantage and Exchange programs. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship responsibility for our customers’ compliance executives.
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The EDI production supports all electronic claim production to various payers, including Medicare, Medi-Cal, Anthem Blue Cross, Blue Shield, and Change Healthcare. Knowledge of contracts, insurance billing requirements, UB04 claim form, worker's compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal and HIPAA compliance program regulations.
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Requires knowledge of Horizon Blue Cross Blue Shield products, Medicaid and Medicare, Department of Health, Federal and State Regulations. and Horizon Blue Cross Blue Shield, and for ensuring that the contractual arrangement is fulfilled.
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OPM, Federal Register, CMS Bulletins, Blue Web Legislative report, etc.) Experience with Medicare Advantage and ACA Exchanges. CHC, CIPM or CIPP Privacy certification, preferred. Collaborates with BCBSM Compliance Office as necessary.
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E-Learning – Comprehensive and current library of e-learning and performance support assets, available on demand and at no cost. Under general direction, the Executive Director, Compliance will lead and provide oversight and management of Compliance and Privacy functions and serve as the company’s Compliance and Privacy Official.
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