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Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
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Thorough understanding of claims and healthcare terminology and codes as published by CPT, ICD, HCPCS, and DRG manuals. The ideal candidate is an accomplished subject matter expert who is passionate in making a real impact on preserving the Medicare Trust Fund. He/she should be a confident public speaker with excellent written and oral presentation skills.
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Demonstrated performance with high volume data analysis and business intelligence tools such as BusinessObjects, SAS, MicroStrategy, Cognos, etc. Works closely with the team to draft and execute an effective end user support and training strategy.
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Maintain knowledge of current laws and regulations related to insurance, Medicare, Medicaid, and DRG coding, sequencing, and CPT coding. Maintain knowledge of current laws and regulations related to insurance, Medicare, Medicaid, and DRG coding, sequencing, and CPT coding.
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Our Solutions include Proclaim (TM) XR SCS System, the #1 Spinal cord stimulator on the market, Proclaim (TM) DRG Neurostimulator, the only FDA approved DRG therapy and a market leader in radiofrequency ablation therapy, Abbott RFA. These non-opioid therapies allow us to provide interventional pain therapy to patients throughout the pain continuum.
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And healthcare payment and coding methodologies (i.e. ICD-9, CPT, DRG and HCC coding) The Senior Director of Risk Adjustment Operations in our Health Plan is responsible the overall development, refinement, maintenance, monitoring and oversight of Medicare Risk Adjustment initiatives and operations.
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Possesses at least 6+ years recent experience with Medicare and/or Medicaid Part A, B, & DME claims, coding, and reimbursement procedures, service and coverage policies, coordination of benefits, as well as provider and beneficiary eligibility.
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Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc. Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture.
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Experience with Business Objects for data mining. Conducts data mining, analysis, and reporting using available tools and data sources. Supports local, offsite and online train-the trainer and end-user training classes with subject matter expertise.
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Understanding of the Centers of Medicare and Medicaid Services (CMS) Integrated Data Repository (IDR) Confident and results-driven self-starter skilled in taking initiative, assessing requirements, coming up with plans, and taking the lead in making plans reality.
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Experience with statistical data analysis techniques such as modeling, aggregation, trending, patterns, random sampling, and ratios to identify outliers. Minimum of a Bachelor's Degree in healthcare or business administration, information technology, public health, or a related discipline, or in another relevant field.
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Assists in the creation and development of various training materials, including trainer guides, training, video or audio, instructor/participant materials, interactive online courseware, and evaluation systems.
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We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees' professional development. Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs.
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Expert knowledge of ICD, CPT, HCPCS coding classifications required and DRG, APC and ASC payment methodology preferred. Certification from AAPC or AHIMA as a Certified Professional Coder (CPC) and Certified Professional Medical Record Auditor (CMPA), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or a Registered Health Information Technician (RHIT) is required.
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Familiarity with clinical data domains and code sets (e.g., CPT, ICD, DRG). Familiarity with clinical data domains and code sets (e.g., CPT, ICD, DRG). Working understanding of provider data concepts such as NPI, Tax ID, practicing location, and specialty.
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