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The CRS manages the overall resident assessment process and tracking of all Medicare/Managed Care/Medicaid case mix documents in order to ensure appropriate and optimal reimbursement for services provided within the Care Center.
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As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
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This position requires a hands-on, self-motivated, experienced individual with established relationships with clients and partners working at or with Department of Health and Human Services (HHS) agencies, preferably the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS.
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Credentialed per Community Health Center Policies and Procedures for billing services under Medicare/Medicaid. Follows established agency policies, procedures, and objectives, continuous quality improvement objectives, and safety, environmental, and/or infection control standards.
$90,000 - $110,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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 ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations. The ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations.
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Follows all Medicare, Medicaid, and HIPAA regulations and requirements. Any specialty area assignment (i.e. critical care, emergency room, psychiatric, pediatric) will require prior recent clinical experience in that specialty area.
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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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Knowledge Healthcare Regulation, HIPAA, GLB and ERISA, and Medicare and/or Medicaid regulations. JD degree from an accredited school, admission to the bar of at least one state. Advise on data privacy, cybersecurity, and HIPAA compliance related to technology and web platforms.
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All employees are required to familiarize themselves and continually comply with all federal and state healthcare laws, regulations and rules (including Medicare and Medicaid billing requirements which are applicable to the employee’s job duties.
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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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Maintain current knowledge of applicable managed care, Medicare and state Medicaid regulations, reimbursement systems and methodology. Director of Nursing, management or supervisor experience in long-term care, restorative or geriatric nursing.
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1+ years of experience with long term care services and support, Medicaid or Medicare. Reliable transportation and the ability to travel in this 'assigned region' to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices.
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The Care Manager is assigned to a specific product line such as FIDA, CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. Fluency in Spanish, Korean, Mandarin, or Cantonese. The Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care.
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Knowledge of external review organizations (i.e. Managed Care, Medicare, Medicaid, state gatekeep for Medicaid). The hours for this position are Saturday and Sunday 7am to 11pm every other weekend.
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