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As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. We are a locally owned, not-for-profit healthcare system comprised of nine hospitals, a statewide health plan and a growing multi-specialty medical group.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and/or Affordable Care Act (ACA) using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, and Centers for Medicare and Medicaid Services (CMS) coding guidelines.
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RN Field Clinical Care CoordinatorHCBS - Ennis, TXFor more information about this role and others, please join us for a virtual hiring information session with Marian Cabanillas, Health Plan CEO, to learn more about our organization, roles available and next steps.
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If appointed you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid.
$120,120 - $129,781 a yearExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Serves on Quality Improvement & Health Equity Committee, Peer Review and Credentialing Committee, Grievance and Appeals Committee, Clinical Operations Committee and Physician Advisory Committees; serves on other committees as required.
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The Licensed Practical Nurse (LPN/LVN) is responsible for providing and documenting skilled nursing care, under the supervision of a Registered Nurse, in accordance with the developed care plan and physicians orders for each individual patient while adhering to confidentiality standards and professional boundaries at all times.
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About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred. One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
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EmblemHealth is seeking innovative and dynamic Sales Professionals to assistand enroll potential members to Individual Medicaid, Essential Plan, Qualified Health Plan (QHP) and Child Health Plus (CHP) products.
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We’re hiring board-certified nurse practitioner contractors to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members. Earn additional compensation via our pay-per-test model (for visits where the health plan member qualifies to receive additional diagnostic and preventive tests.
$2,500 - $4,000 a weekFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Support the development of a 3 to 5-year Duals product and growth strategy for the Health Plan and lead coordinating and facilitating enterprise product/process innovation and development activities.
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The combined role will be pivotal in several areas of the organization, including but not limited to: Utilization Review, Improving Quality Metrics, Integration of Value-Based Performance and Health Plan alignment, being a Change Agent with physician performance, Clinical Documentation, and Population Health.
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Health, life, and dental insurance, retirement plan, and paid relocation. Must be eligible as a provider for Medicare, Medicaid, and other federal heath programs. Licensed by the Federal Drug Enforcement Administration and the State of Illinois to prescribe narcotics, if applicable.
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