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Experience working with managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment; Knowledge and expertise in managed care claims, third-party liability, Medicaid waiver programs, and/or provider enrollment.
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This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for Accounting.
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MMM Holdings, LLC is a company that provides Medicare Advantage and Medicaid plans in Puerto Rico. Currently, MMM Holdings, LLC operates in Puerto Rico under Elevance Health, Inc. a leading health company dedicated to improving the quality of life of communities in the United States.
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Experience with Medicaid, Medicare and commercial claims filling and insurance verification. The Medical Billing & Coding Specialist will provide administrative support and collaboration with the CFO & Revenue Cycle Manager in establishing coding, billing, and payment for all medical services.
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Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor.
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Prior state government/public sector experience with health and human services programs (such as Medicaid, Medicaid Management Information System (MMIS), claims processing, eligibility, HHS analytics, Eligibility and Enrollment systems (i.e., NC FAST), etc.
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At least 0-2 years experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services and /or public services or public benefits programs with claims and Medicare experience.
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The Compliance Auditor - OP/Ambulatory Services educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements to maximize reimbursement.
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Submit Medicaid claims on scheduled date in accordance with Nexion billing schedule. Atttend LOC and Triple Check meetings to ensure accurate and timely billing of Medicaid, Medicare, and Managed Care claims.
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Working knowledge of health care EMR or claims systems (Epic/Clarity, eCW, Facets, QNXT, Amisys, etc.) Knowledge of New York State Medicaid and CMS Medicare regulations and related reporting requirements such as STARS, QARR, MMCOR, MEDS, RAPS, EDGE and HEDIS required.
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As a medical coding and billing specialist, you will review patient medical records and assign codes to diagnoses and procedures performed so the facility can bill insurance and other third-party payers (such as Medicare or Medicaid) as well as the patient.
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Coordinate with Residents, Responsible Parties and Caseworkers in the Medicaid eligibility application/recertification process. This includes all Medicare, Medicaid, Managed Care and Insurance payments.
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The Pharmacy Billing Specialist is responsible for electronic billing of Medicare, Medicaid and Third Party Insurance claims, utilizing Frameworks LTC Pharmacy system. Electronic billing of Medicare, Medicaid and Third Party Insurance claims utilizing Framework LTC Pharmacy system.
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Partner with Billing Specialists to ensure accurate processing and billing of Medicare, Medicaid, Managed Care, Worker’s Compensation, other government programs, motor vehicle, personal injury and protections, third party payer experience, self-payer/uninsured and commercial insurance processing patient claims in accordance with payer requirements and organization policy.
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This position requires a minimum of 1 year Medicare, Medicaid and Managed Care billing experience in a SNFsetting. Submit Medicare and Managed Care claims by the 6th business day of the month.
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medicaid claims jobs
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