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Reporting to the Senior Manager of Medicare Regulatory Compliance, the Medicare Regulatory Compliance Specialist will support the oversight and management of the Medicare Compliance Program.
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Compliance oversight for "Schedule A" request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA. Compliance oversight for "Schedule A" request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA.
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Responsibilities Job DescriptionThe Sr Financial Analyst maintains current knowledge of the Medicare Cost Report regulations related to SOT and uses that knowledge to ensure all data vital is present to assure accurate MCR reporting.
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Is knowledgeable about EMTALA regulations and reporting of child/adult abuse to appropriate agencies and Hospital Social Worker. Riverview is also the areas highest rated hospital, receiving Four-Stars from the Centers for Medicare and Medicaid (CMS.
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Keeps abreast and knowledgeable about ongoing and emerging Infection Prevention and Control topics, regulatory requirements, and quality and reporting metrics as determined by CHE Trinity, the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, local, state, and national health departments.
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The Executive Director ensures effective synchronization of staffing, technology (video surveillance, access control, alarms/detection, programming, software, et al), and processes (incident reporting, data analysis, measurement, budgeting, repair & maintenance, investigations and threat assessment, event reconstruction, training, crime prevention, et al), to safeguard people, property, assets, and interests.
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Ensure Account Manager is performing all tasks as outlined in the MMA Assistant Account Manager or Account Manager Job Description. Assist bSwift team with set-up of client web site as directed by Benefits Operations Manager.
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All work will be carried out in accordance with the: International Classification of Diseases - Official Coding Guidelines for coding and reporting as established by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS); American Medical Association (CPT); National Correct Coding Initiative (NCCI); Uniform Hospital Discharge Data Set (UHDDS), Medicaid (OMAP), and Kaiser Permanente organization/institutional coding directives.
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Excellent knowledge of the Commercial, Medicare, HMO, and PPO Programs particularly as it relates to CPT procedures and ICD-10 diagnostic coding and billing. Reporting to the Senior Vice President, Operations and Support Services, the Vice President, Ancillary and Laboratory Services will develop and lead a team of imaging, pharmacy and laboratory leaders for the coordination and execution of inter-company services and attainment of identified key goals and performance indicators as identified by the executive leadership team and board of directors.
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Responsible for Quality & Controls Assurance programs, activities and reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment, HCC, clinical and coding reviews; DRG and medical records reviews; technology/systems and coding upgrade and implementation reviews (e.g. final user acceptance testing, etc.
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Some examples of specific operating requirements: Centers for Medicare & Medicaid Services (CMS) Conditions of Participation for Hospitals, Medicare Claims Processing Manual, Diagnostic and Statistical Manual of Mental Disorders (DSM), Current Procedural Terminology (CPT), International Statistical Classification of Diseases and Related Health Problems (ICD), Health Insurance Portability and Accountability Act of 1996 (HIPAA), and ICD Official Guidelines for Coding and Reporting.
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Full ownership and accountability for all Quality & Controls Assurance programs, activities and reviews, including claims reviews; call center and digital communications reviews; Medicare Risk Adjustment, HCC, clinical and coding reviews; DRG and medical records reviews; technology/systems and coding upgrade and implementation reviews (e.g. final user acceptance testing, etc.
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Plan and manage the implementation of new instrumentation in accordance with SPD management and regulatory standards including the State Department of Health Joint Commission and Center for Medicare Services.
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We are currently seeking a part-time (20 hours) licensed behavioral health clinician in our Norwich Health Center to provide clinical services for individuals, children, families, couples, and/or groups of all ages regarding behavioral, substance abuse, psychiatric, or emotional issues through the development and implementation of clinical assessments, treatment plans, and discharge plans with a specific practice focus serving Medicare insured clients.
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Medicare Advantage (MA) risk adjustment is responsible for the development and management of pricing, forecasting, and reporting architecture related to CMS risk-adjustable revenue for Medicare related products within Emerging Markets.
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medicare reporting jobs
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