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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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Work you’ll doProvide expertise on Medicare (preferably Claims) Healthcare AnalyticsDevelop healthcare data analysis visualizations and support data linkages to those visualizationsPerform data modeling, database development and managementDevelop user stories and mockups for data visualizationPerform coding and testing of data visualizations using open source or visualization packages such as Tableau.
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The Deputy Chief Operating Officer (DCOO) is a member of MetroPlusHealth’s Senior Management team and is vital in providing assistance with the oversight, management, and supervision of Operations, in a matrix organizational structure including: PMO, Process Improvement, Provider Network Operations, Call Center, Credentialing, Facilities, Enrollment & Membership, Vendor Management, Customer Success, and Claims.
$260,000 - $287,000 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Under the supervision of the Revenue Cycle Manager, this position is responsible for the timely and accurate billing of commercial/group insurance/Medicare/Medi-Cal/managed care and self-pay home health/hospice accounts, posting of payments/remittance advices, review of unpaid claims/patient accounts and use procedural guidelines to reduce the outstanding dollars on accounts receivable.
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Analyze the impact and application of federal and state health care laws and regulations, including Anti-Kickback statute, Stark law, False Claims Act, HIPAA, fraud and abuse laws, the Affordable Care Act, and Medicare related regulations in relation to the clinical, strategic, and business operations of the Company.
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We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members.
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7+ years working in risk adjustment leadership roles in a Medicare Advantage environment with detailed knowledge of the CMS RAF model as well as experience working with healthcare data, specifically medical claims and/or encounter data.
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Responsible for Claims Department and Provider Services Department compliance with all Medicare and Medi-Cal regulatory requirements. Participates in all Claims Department and Provider Disputes compliance audits, such as Medicare Finance audit, DMHC claims audit, CMS data validation audit, etc.
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Coding and submitting claims to payers and government programs, such as Medicare and Medicaid. Working with payers to resolve claims that are denied or underpaid. Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines is often required, along with certification in medical coding and/or revenue cycle management.
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Providing sound, practical judgment in the interpretation and application of relevant laws and regulations, including the Anti-Kickback Statute, the Beneficiary Inducement Statute, Medicare/Medicaid, False Claims Act, Stark Law, HIPAA and state health information privacy laws, and marketing and advertising laws applicable to the marketing and promotion of medical products.
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Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
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Verifying daily Census Verify all billing and financial data for new admissions Medicare A & B Billing, Claims Corrections and Follow-up Managed Care , Claims Corrections and Follow-up Private Pay Billing and Collections.
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Substantive experience with federal criminal practice or government investigations, including matters related to the False Claims Act, Anti-kickback statute, Medicare and Medicaid compliance, OIG/DOJ investigations, and healthcare fraud, is advantageous for this role.
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Health Plan (claims, membership, medicare) JIRA, Confluence, RTC. Perfict Global is a leading IT consulting services provider focused on providing innovative and successful business workforce solutions to Fortune 500 companies.
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Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections.
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medicare claims jobs
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