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As a Medical Records Coordinator, you will be responsible for assisting as needed in the day-to-day HIM departmental clerical activities (e.g. working the Horizon Patient Folder (HPF)/McKesson Patient Folder (MPF) workflow queues, resolving unbilled accounts, facilitating the physician suspension process, etc.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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The QC Supervisor provides on-site programmatic oversight of all federally mandated policy, procedural and programmatic review activities for the Supplemental Nutrition Assistance Program (SNAP) and the Medicaid (MC) Program.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Advanced in Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software) Proficient in Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software.
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Also included under the oversight of the CFO is Revenue Cycle Management, Patient Experience, Accounts Payable management, Budget & Forecasting, Payroll, Cash Management, General Ledger, Account Reconciliation, Population Health and Grants Management, Health Resource and Services Administration (HRSA) grant reporting as related to the Electronic Handbook (EHB) and Uniform Data Systems (UDS), Medicare and Medicaid Cost Report activities.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Serves as a subject matter expert for clinical documentation integrity (CDI), Case Mix Index (CMI) and multiple reimbursement systems (i.e., APR-DRG, Medicare, Medicaid, etc.) Responsible for CDI program to initiate, influence, direct and oversee the clinical documentation improvement program activities to include productivity, quality, education and training, auditing, report management, performance improvement initiatives, and developing standardized practices, processes, policies and procedures.
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Overseeing the coordination of HEDIS data ingestion activities and driving strategy to optimize HEDIS data ingestion, EHR/HIE interoperability, supplemental data, and record review for the Medicaid line of business.
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The Senior Quality Compliance Professional uses quality compliance and improvement tools and methodology to assess, implement, and evaluate activities to monitor and continuously improve EPSDT and maternal health services and rates for Oklahoma Medicaid enrollees.
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Oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. The work section is responsible for researching, verifying and validating the Electronic Data Interchange (EDI) technical functions of the Enterprise Solutions Integrator platform (ESI), the Colorado interChange System, the Pharmacy Benefits Management System and the Business Intelligence Data Management (BIDM) system, which includes working with UAT Tester's to review user acceptance testing activities or testing system processes in the test environment to determine system functionality.
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Supporting Medicaid Business Development efforts by assisting in data parade preparation and response development for all Medicaid RFP activities. The HEDIS Data and Reporting Lead reports to the National Medicaid Quality Director and oversees and coordinates all aspects of HEDIS data collection strategy, analytics, and reporting for the Humana Healthy Horizons Medicaid business, and leads the National Medicaid Quality Analytics team.
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Documents all activities in denials management and financial systems to ensure timely handoffs. Two (2) years of experience in hospital billing or insurance pre-certification required; Must be familiar with healthcare billing and insurance regulations such as those required by Medicare, Medicaid or Commercial payers.
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Humana is seeking a HEDIS Data and Reporting Lead to join the National Medicaid Quality team. Coordinating study designs for pilots and innovations by managing data science personnel within the National Medicaid Quality Analytics team.
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In collaboration with the Emergency Preparedness Clinical Educator, this position is responsible for ensuring that the entity is compliant with disaster preparedness education and training as required by The Joint Commission (TJC), Cal/OSHA, Centers for Medicare and Medicaid Services, California Department of Public Health, California Environmental Protection Agency, California Department of Toxic Substances Control, and other applicable regulatory agencies.
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Medicaid Quality Experience, preferably in the managed care setting. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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HEDIS Data and Reporting Lead, Medicaid Quality. Managing a team of Data and Reporting Professionals, BI Engineers, and Data Scientists, all dedicated to Humana's Medicaid business at the national level.
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The MHRS-RN is directly responsible for conducting Mental Health Rehabilitation Service (MHRS) activities in accordance with the regulations of the Department of Behavioral Health and VOA Hope Center- DCs operation as a Mental Health Rehabilitation Service Core Service Agency.
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