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Interfaces with Government owned and operated web-based application tool (Health Plan Management System), used for Federal regulatory oversight of Medicare health plans. Maintains internal database of Medicare marketing materials; includes but is not limited to data entry, data validation, and executing monthly QA processes.
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Michigan Medicine Finance is seeking a reimbursement analyst to provide support for cost report preparation, cost report appeals, audit preparation, revenue recognition, ad-hoc reporting, and other duties related to the regulatory reimbursement services of Michigan Medicine and it’s affiliates.
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Health care regulatory knowledge focusing on Fraud, Waste, and Abuse; knowledge of Value-based care, Medicare Advantage Organizations, ACO REACH and MSSP programs is required. This role will provide regulatory guidance on various healthcare-related issues with a focus on Anti-kickback Statute (and related state statutes), Stark Law, Civil Monetary Penalties Law, and develop compliant solutions to to facilitate and promote One Medical’s business objectives, including value-based care, care coordination, and clinical integration.
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This role owns the internal Medicare Advantage Sales CRM tool, including development of reporting, and leads the telephonic sales team members by ensuring quality service, regulatory compliance, and positive team member engagement.
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Adheres to regulatory requirements, e.g., DPH, TJC, DMH, Medicare, etc. Adheres to regulatory requirements, e.g., DPH, TJC, DMH, Medicare, etc. Union Name: MNA Everett. Actively engages as a “super user” or “unit champion” during roll out of new products equipment, processes, e.g., EPIC, rounding, code chill, etc.
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Requires five (5) years’ experience with knowledge of laws and regulations pertaining to health care, regulatory compliance, hospital and/or physician billing and information systems, Medicare/Medicaid and financial reimbursement systems, and HIPAA Privacy and Security issues.
Full-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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Knowledge of accepted professional standards and practice, Medicare Conditions of Participation, and federal, state, and local regulatory requirements Required Certifications and Licensures: Registered nurse with current licensure to practice nursing in the practicing state.
$10ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The position will work in accordance with the Center for Medicare/Medicaid Services (CMS) guidelines to ensure regulatory compliance takes place. Our contingent workforce plays a critical role in working with our new and existing Medicare member clients to process enrollments and various other requests.
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Strong understanding of health plan, healthcare provider & vendor contracting and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization.
$95,000 - $125,000 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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The Job This role, Network Compliance Auditor (FSR) Nurse, performs all aspects of a Facility Site Review (FSR), using regulatory requirements, to test, monitor, document and report the overall level of compliance of the First Tier, Downstream and related entities (FDR) to ensure compliance with all applicable requirements; SCAN, Federal, State and National Committee for Quality Assurance (NCQA) requirements.
$38.61 - $61.78 an hourExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Knowledge of accepted professional standards and practice, Medicare Conditions of Participation, and federal, state, and local regulatory requirements. Previous experience in home care setting with two years management or supervisory experience, preferred.
$80,000 - $95,000 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Professional performance is to be delivered in a manner that is compliant with the regulations and guidelines of all relevant regulating bodies (e.g. the American Society of Anesthesiologists, JCAHO, Centers for Medicare and Medicaid, OHSU IRB, NIH and all other state, federal, and institutional regulatory guidelines.
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Familiarity with Chapter 2 - Medicare Advantage Enrollment and Disenrollment guidance. Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions.
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SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada.
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Comply with all regulatory guidance including but not limited to HIPAA, Medicare rules and billing and coding guidance. Leadership and talent development to teach our therapists how to manage people, develop social and emotional intelligence and run a clinic.
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