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The Manager, Medicare Risk Adjustment has organization level responsibilities for the administration of all provisions/requirements of HMSA's Medicare Risk Adjustment program. Provides education and information to the entire HMSA community regarding Medicare Advantage risk adjustment.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintain PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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Sound Physicians formed a Medicare Accountable Care Organization called Sound Physicians Long Term Care Management, LLC (SLTCM) which is a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) for Medicare Beneficiaries who reside in long-term care (LTC) facilities.
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Ciena Healthcare is Michigan’s largest provider of skilled nursing and rehabilitation care services. About Ciena Healthcare. The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned.
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Whether helping you apply for Medicaid, Medicare, arranging CDPAP,or coordinating coverage for Holocaust survivors, we do whatever ittakes to make sure everyone feels right at home. /r/nWhether helping you apply for Medicaid, Medicare, arranging CDPAP,/r/nor coordinating coverage for Holocaust survivors, we do whatever it/r/ntakes to make sure everyone feels right at home.
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Job DescriptionJob DescriptionSummary:The Medicare Risk Adjustment Coder will be responsible for coordinating/supporting retrospective and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data.
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The programs the AVP will have oversight for include but are not limited to: MACRA/MIPS, 21st Century CURES, Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage; and commercial payer value programs.
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At least 0-2 years experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services and /or public services or public benefits programs with claims and Medicare experience.
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The Assistant General Counsel I supports and reports to the Chief Legal Officer and provides legal advice on a wide variety of matters related to Community's Medicare, Medicaid and Marketplace programs and operations including contracting, quality, utilization management, network management, privacy and security, litigation, fraud, waste and abuse, and contractual and regulatory compliance.
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Sound Physicians is forming its own Medicare Accountable Care Organization called Sound Physicians Long Term Care Management, LLC (LTCM) which will be a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) for Medicare Beneficiaries who reside in long-term care (LTC) facilities.
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An active, independent Texas Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Clinical Psychologist Residence in Texas Though we do not require our providers to see Medicare patients, you must not have opted out from Medicare Have access to reliable and stable internet while working remotely; experience with Google Suite is a plus.
$38 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Will be knowledgeable of state and federal government funding programs such as Medicare, Medicaid, TRICARE/CHAMPUS, Workers' Compensation; No Fault Auto, and commercial insurance payers; billing and reimbursement guidelines and methodologies for state and federal government and non-government payers; insurance terminology; medical terminology, EMTALA, HIPAA privacy, and compliance practices.
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To be considered for this position you must have at least 2 years of Health or Medicare Insurance sales experience and have worked 2 Annual/Open Enrollment Periods. 2 years of Individual health or Medicare Insurance sales.
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Knowledge of Medicare Risk Adjustment required. SUMMARY: Risk Adjustment Coder is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10 coding and compliance with risk adjustment requirements.
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The wellness premium applies only to the Blue Cross Blue Shield Hospital Medical Group #14000 plan for non-Medicare eligible active and retired members, non-Medicare-eligible members on LOA or COBRA, and non-Medicare-eligible spouses on active or retired contracts.
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