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The Intake Coordinator will process Healthy Start pre- and post-natal risk screens and community referrals received from the local health department, and women with SOBRA Medicaid in Miami Dade County.
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Maintains 100 % compliance with confidentiality protocols as well as the security and integrity of the ADAP Electronic Enrollment System as determined by the Florida Department of Health HIV/AIDS Section of the Bureau of Communicable Diseases, as well as all other databases, including Medicaid, Health Management System (HMS), Availity, Change Revenue as assigned.
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Identifies/reviews services requiring pre-authorization/pre-certification by Medicare, Medicaid, Commercial, and Managed Care payers, to ensure provider eligibility requirements are met prior to receiving service.
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Guides members to maintain Medicaid eligibility and with other financial resources as appropriate. Current Community Health Worker (CHW) Certification preferred (for states other than Ohio and Florida, where it is required.
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The purpose of the Sr. Patient Registration Specialist is to conduct the eligibility verification screening, documentation collection, and financial assessments for all clinic patients accessing services, including verifying eligibility for HIP and Ryan White funded programs, Patient Protection and Affordable Care Act insurances, and Medicaid or Medicare.
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Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components Knowledge of Medicare, Medicaid and Managed Care requirements Comprehensive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local and federal programs Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
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Experience on an Integrated Eligibility projects with the knowledge on State and Federal programs like SNAP, TANF, Medicaid etc. Some areas that we focus on include Children Services, Eligibility & Enrollment, Child Support Enforcement, and Labor & Workforce Development.
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As an Eligibility Screener, you would be responsible for completing the Adult Long-Term Care Functional Screens (LTC-FS) for participants of the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities.
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State government/public sector experience with health and human services programs (such as Medicaid, MMIS, claims processing, eligibility, HHS analytics, etc.) 3+ years of Medicaid, MMIS, claims process or related experience.
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Coordinating Medicaid/SSI/SNAP eligibility and recertification. The Assistant Director leads a team of professionals who are facilitators, mentors, and agents for meaningful choice for the people who chose to make a Springbrook home their home.
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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. Benefits: Volt offers benefits (based on eligibility) that include the following: health, dental, vision, term life, short term disability, AD&D, 401(k), Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP.
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Conducts intensive screening of all Medicare, Medicaid and managed care patients for pre-certification requirements and provider service eligibility, prior to registration. Makes personal contact with patient or guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs (namely Medicaid.
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Strict adherence to eligibility and enrollment criteria governed by the Centers for Medicare & Medicaid Services (CMS) Medicare Managed Care Manual. In addition, the Revenue Specialist performs complex reconciliation, auditing and system improvement processes.
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Medicare and Medicaid Eligibility: Hospice Physician is and shall always remain a qualified Medicare and Medicaid provider. Hospice Physician represents and warrants that they have never been excluded from participation in any federally funded health care program including, without limitation, Medicare, Medicaid, or TRICARE, nor has been convicted or found to have violated any federal or state fraud and abuse law or illegal remuneration law.
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Minimum three (3) years of Medicaid clinical eligibility assessment training experience, including experience with Inter-rater Reliability processes. As an Education and Training Manager at Telligen you will be responsible for developing a comprehensive education and training program for staff, Providers, Health Plans, PACE Organizations, Members, and other stakeholders to support the implementation and ongoing operations for State Medicaid/Medicare Solutions.
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