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Ensures a comprehensive understanding of managed care contracts and adheres to regulatory reporting and compliance for Medicare/Medicaid (AHCCCS) and various governmental or payor guidelines/directives.
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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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What we need from you:Prior experience in a Skilled Nursing Facility (SNF) is requiredExperience with Public Aide / Medicaid billing and collections is required Previous experience with Medicare / Managed Care billing is helpfulPoint Click Care (PCC) software experience is idealPlease specify detailed billing experience (when, where, how often, collectables.
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Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan.
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The Director is accountable for the effective direction and management of ARHs Accountable Care Organization, ARH CMS Bundled Payment Initiatives, Future Provider Medicare Advantage Plans, and Medicaid Reimbursement Programs.
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MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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We CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.
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Facilitates collection, validation, distribution and follow-through support of monthly and quarterly HCC coding reports for allproviders participating in the Managed Medicare Program and Accountable Care Organization Programs.
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Perform DME billing for Medicare, Medicaid, Tricare, and other private insurances. Required - High School diploma or equivalent plus 2 years' experience in Medicare/Medicaid and commercial billing - preferably in Durable Medical Equipment setting.
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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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Job Type Full-time Description Locations vary: Downtown Palo Alto -CSR - Covid Berto Guerra Berto Guerra Dental Walzem Walzem Dental South Park Haven for Hope - Homeless specialty Converse Barlite - OB/GYN COMPANY OVERVIEW CentroMed is 501(c) (3) non-profit organization that provides healthcare for all populations is a primary care provider and Federally Qualified Health Center (FQHC) with multiple locations throughout San Antonio and the New Braunfels area.
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Human Resources functions as needed by the facility Administrator What you need as a Business Office Manager Medicare/Medicaid Billing Experience Preferred Office Experience in a Long-Term Care Facility STRONGLY preferred Strong Organizational Skills About our parent company Guardian Healthcare Guardian Healthcare is both our name and our philosophy.
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Experience with Medicare or Medicaid, DSNP, MAPD, MME as well as commercial insurance, and/or LTC/LTSS organization. Keeping the patient and member at the center, this leader will drive the strategy and execution of Optum at Home. The leader will also lead our collaboration with UnitedHealth Care in the management of Medicare Advantage Individual and Dual Special Needs populations.
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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. ACLS: Emergency Department, Critical Care, Cardiovascular Lab, GI Lab, Interventional Radiology, Progressive Care, Surgical Services Pre-Op and Recovery Room.
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Uses the MEVSNET, Florida Medicaid Web Portal, Availity and SSI Clearinghouse system to verify Medicare, Medicaid, and/or commercial insurance coverage for all admissions. Ability to operate all required computer hardware and software to include the Mevsnet, Medicaid Web Portal System, Availity and SSI Clearinghouse.
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medicare medicaid accountable care organization jobs Title: general counsel
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