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The Provider Enrollment Representative will facilitate activities from the point of the provider candidate's acceptance of employment to the point of the candidate's approved enrollment with DC, Maryland, Virginia and West Virginia Medicaid and Medicare.
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Medicare knowledge required with minimum of one year of Medicare sales and one Annual Enrollment Period preferred. As a Medicare Sales Agent (internally titled Advocate Agent) you'll enjoy unlimited earning potential, the convenience to work from home, access to best-in-class paid training, and potentially the opportunity to move into a leadership role.
$44,632 a yearExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and "How-To" documents.
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General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred. Exact job experience is considered any of the above tasks in a Medicare certified.
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Must understand Medicare, Medicaid, and manage d care plan credentialing requirements, and must be familiar with CAQH (Council for Affordable Quality Healthcare) At least three (3) years of medical credentialing and enrollment experience.
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Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required. Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs.
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Must possess active Medicare/Medicaid Enrollment or be eligible to enroll. Must possess active Drug Enforcement Agency (DEA) registration or be eligible for registration. Malpractice Insurance Continuing Medical Education (CME) Reimbursement.
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Basic knowledge of Medicare regulations, experience in Managed Care Enrollment (MA, MAPD and PDP), Other Skills: Must possess previous experience processing Medicare Advantage enrollment applications and generating lettersAbility to effectively communicate in English, both verbally and in writing.
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The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls. Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles.
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The Patient Assistance Counselor maintains a thorough knowledge of health care coverage opportunities available through local, state or federal and pharmaceutical programs and Foundation grants, and assists with outreach and enrollment to bridge patients with these resources.
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Understands the Medicare Benefit for Chronic Care Management (CCM) and Transitional Care Management (TMC) and articulates to the client/patient the benefits of the program and the impact to their continued wellness plan.
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Industry Knowledge:Strong knowledge of medical terminology, eligibility and enrollment requirements for Medicare, Medi-Cal, Workers’ Comp, Managed Care (HMO, PPO, POS, etc.) Industry Knowledge:Strong knowledge of medical terminology, eligibility and enrollment requirements for Medicare, Medi-Cal, Workers’ Comp, Managed Care (HMO, PPO, POS, etc.
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Must have considerable knowledge of Medicaid, Medicare and long-term services and supports. Have oversight and supervision of pre-enrollment activities performed by PACE organizations. Assess and document the program, conducting monitoring visits and annual on-site audits to evaluate organizations compliance to PACE policy (periodic overnight stays required.
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At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives - out of the hospital and in their homes. Actively listens to patients and handle stressful situations with compassion and empathy.
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Annual Medicare cost report; 3. Ability to complete and submit Provider Enrollment applications in Out of State Medicaid plans and furnish documentation as requested by these plans. Four years' progressive experience in hospital reimbursement with extensive experience in preparation of Medicare cost reports for IPPS teaching hospitals, Critical Access and FQHC cost reports.
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