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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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The Account Manager is responsible for enrolling Medicare members through group and in-home sales presentations. Group or Medicare health insurance sales experience with managed care or indemnity products preferred.
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Experience or understanding of Medicare and Medicaid claims, ICD10 codes, HCPCS, Diagnosis Related Groups (DRG). Build models and conduct analytics that contribute to Medicare and Medicaid fraud, waste and abuse efforts.
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Continuously learns Medicare and Medicaid policy and policy changes. Proficient in project software such as SAS/SQL, Python/PySpark, Snowflake, R, Databricks CMS cloud environments. Builds complex models for specific analysis using technology such as Python (Python, PySpark), R, SQL, SAS, Databricks.
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Job Description :Audit & Reimbursement III - Medicare Cost Report AuditLocations: This is a virtual position; the ideal candidate will live within 50 miles of an Elevance Health PulsePoint location.
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Continuously evaluate impacts of policy and policy changes on fraud detection models. Uses this knowledge to construct fraud detection models. Relevant experience in a health-related, scientific, or public policy/business discipline with extensive quantitative methods/statistical knowledge.
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The Senior Data Analyst works independently and collaboratively with Statistical and Data Analysts to provide analytical data support. Minimum 4-year degree in statistics, mathematics, computer science or related field or possesses a minimum of 6 years of data analysis experience within the healthcare industry.
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The Medicare Risk Adjustment Advanced Analytic Senior Is responsible for creating statistical models to predict, classify, quantify, and/or forecast business metrics. Medicare Risk Adjustment Advanced Analytic Senior.
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Medicare Risk Adjustment Advanced Analyst Sr. Medicare Advantage and Medicaid (Dual Members) risk adjustment experience preferred. Medicare Risk Adjustment Advanced Analyst Sr. Requires MS, MA, or PhD with concentration in a quantitative discipline such as statistics, computer science, cognitive science, economics, or operations research, a minimum of 3 years direct experience programming large, multi-source datasets with SAS required, and a minimum of 3 years in health care setting; or any combination of education and experience which would provide an equivalent background.
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Must have 3+ years of experience in Medicare/Medicare Advantage along with value based care. Analysis of Medicare Advantage and Accountable Care Organization data primarily. Experience in the annual Medicare Advantage bid development process is a plus.
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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
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Knowledge of Medicare Important Message, Medicare Secondary Payor, Tricare Third Party Liability; Auto Accident and Work Comp, Medicare/Outpatient Observation Notice. In cases where Tricare or Medicare/Medicare Advantage is primary or secondary, use scripting to review and deliver appropriate regulatory form (Tricare Rights, Tricare Third Party Liability, and Important Message from Medicare (IMM) form.
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This position will support Medicare Risk Adjustment activities including ACO REACH, MSSP and Medicare Advantage activities. Serves both internal and external customers, identifies opportunities for improvement throughout the Medicare risk adjustment process.
$100,000 - $231,500 a yearFull-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Intermediate to Advanced expertise with software such as SAS Stat, SAS ETS, SAS Enterprise Miner or equivalents strongly preferred. Experience with ACA Risk adjustment, Star, and Medicaid quality incentives preferred.
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Experience with Teradata, SQL, SQL Server, or equivalent strongly preferred. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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