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Knowledge of CMS claims data, including Medicare, Medicaid, in the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System (T-MSIS), or Prescription Drug Event (PDE) data.
$106,200 - $242,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), FSA, foreign claims, outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, and Medicare Secondary Payer (MSP) by calculating benefit due to approve or deny, based on SPD.
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Avosys is seeking a Bexar County Remote Registered Nurse - Medical Review Specialist to work remotely to review Medicare claims. Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the “Services”) in accordance with CMS (Centers for Medicare & Medicaid Services) requirements.
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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.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Advise on relevant federal and state laws, including but not limited to fraud and abuse laws (i.e. Anti-kickback Statute, Stark, Civil Monetary Penalties Law, False Claims Act), licensing and accreditation, HIPAA/HITECH, EMTALA, digital health, telehealth/telemedicine, medical staff/peer review issues, healthcare compliance matters, billing, reimbursement and claims issues (to include Medicare/Medicaid.
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We process claims and provide customer service support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad.
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Work all assigned billing edits related to cardiac cath and interventional radiology technical claims within nThrive claims and Charge Capture Audit (CCA). For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.
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Identifies opportunities in the review of claims by establishing standards of review of duplicate claims using Centers for Medicare & Medicaid Services (CMS) evaluation as a guide.
$300,000 - $350,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Billing & Accounting Specialist will be responsible for accurately processing billing documentation, handling claims, ensuring compliance with Medicare and Medicaid regulations, and assisting with accounting related tasks.
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We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad.
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The actuary will be a key person on the Accountable Care team that analyzes various sources of patient health and claims data to help the business understand, forecast and manage the risk position of various value-based products (MSSP, ACO REACH, Medicare Advantage.
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Bachelor's level degree and/or equivalent experience in claims and litigation management, Risk Management or malpractice litigation field. Generates various mandated reports/notifications to legal counsel, excess insurance carriers, Medicare, Captive Board, Actuaries, Finance Department and Auditors, and establishes/maintains a tracking system to assure timely notification.
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The successful candidate will have strong knowledge of and deep expertise in working with large Medicare claims dataset, conducting actuarial and risk adjustment (CMS-HCC) analysis. Analyze various sources of patient care and claims data, including 100% Medicare data or VRDC, to provide actionable insights to stakeholders.
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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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