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O Minimum of two (2) years of experience in: Electronic health record systems analysis, design, build, and support, Epic application implementation, troubleshooting, testing, and support, Medical billing, claims, or other related areas of the revenue cycle, California with complicated payor requirements, Demonstrable knowledge of regulatory billing requirements by CMS, Medicaid, and other payors.
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As Actuary on the Unit Cost Analysis and Management team within Humana's Provider Analytics organization, you will enable sustainable growth and support Humana's Health First purpose by executing and enhancing unit cost projection processes, primarily focused on our Medicare Advantage business.
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Participating in expanded use in Medicare of relevant components of the Medicaid Unit Cost Model on Azure Synapse Analytics, winner of the 2023 Actuarial Innovation Contest and the 2023 PALS Awards Most Advanced category.
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These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending.
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The Service Center provides budgetary and fiscal analysis for many complex areas within DHHS, including TANF (i.e. Temporary Assistance for Needy Families) and MaineCare (Maine’s Medicaid Program.
$47,840 - $64,542.4 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Distribute and track all Medicare Advantage and PACE regulatory and sub-regulatory guidance received from CMS via HPMS, including summary analysis, distribution to business owners, impact on operations, and any associated deadlines.
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As the Director, you will play a crucial role in shaping and overseeing HAP's Medicare financials analysis, medical expense budgeting, and coordination with consulting actuaries. Provide valuable insights and recommendations based on data analysis and actuarial expertise, contributing to the achievement of HAP's long-term goals.
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Knowledge of Medicaid billing and reimbursement necessary. This will include direct responsibility for accounting, finance, forecasting, strategic planning, job costing, legal, property management, deal analysis and negotiations, plus private and institutional financing.
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This position manages the distribution and tracking of Medicare Advantage and PACE regulatory and sub-regulatory guidance from the Centers for Medicare & Medicaid Services (CMS) via HPMS memos to ensure timeliness and applicable deadlines are met; this includes items such as the annual rate notices, plan reminders of required actions and deadlines, and manual revisions.
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Coordinate and ensure compliance with regulatory requirements, such as medical coding and billing guidelines, Medicare/Medicaid regulations, and HIPAA. 7. Strong understanding of financial analysis, budgeting, and forecasting techniques.
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Member and provider satisfaction survey development, fielding, vendor management and analysis, supporting new business development/RFP decision making related to accreditation and certification process, rules and implementation timelines.
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One of our clients in Norfolk, Virginia is looking for a QNXT Benefits Configuration Analyst with the following skills and experience: MUST HAVE : FL Medicaid experience. Beacon Hill Technologies covers a broad spectrum of IT positions, including Project Management and Business Analysis, Programming/Development, Database, Infrastructure, Quality Assurance, Production/Support and ERP roles.
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Serco is seeking a motivated Policy Specialist for Medical Claims Review to join our talented and fast-paced Public Sector Solutions team in supporting CMS’ implementation of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children’s Health Insurance Program (CHIP) improper payment estimates as required by the Payment Integrity Information Act of 2019 (PIIA.
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Fundamental understanding of the various required Federal pricing programs in the market: FSS pricing, PHS pricing, State Medicaid, 340B and ASP reporting. 5-7 years of working in with Trade Channel segment customers; 3+ years pharmaceutical industry experience working in/with Finance, Market Research, Supply Chain Analysis, Specialty Distributors and Specialty Pharmacies; strong understanding of typical functions and procedures.
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Minimum seven (7) years' Medicaid, Medicare, Medicare Stars, Medicare Risk Adjustment, and Government health insurance related data analysis experience required. Minimum four (4) years’ experience in the application of business analysis or data management and analysis tools including but not limited to, SAS, SQL, AQT, Tableau, and PowerBI required.
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