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This position is also responsible for auditing medical record documentation to determine appropriate diagnostic coding for services provided, taking into account the AMA CPT coding guidelines, ICD-9 & ICD-10 Coding Guidelines, CMS Medicare, HHS, and DHS BadgerCare Plus risk adjustment policy and Hierarchical Condition Category Coding.
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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.
$123,000 - $219,000 a yearFull-timeRemoteExpandUpdated Today - UpvoteDownvoteShare Job
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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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Analyze and develop new to market assessments and modeling which includes future Medicare geographic expansion and enhancements / changes to other market segments (Commercial potentially). Medicare Risk score projections and Premium estimation.
$123,000 - $219,000 a yearFull-timeRemoteExpandUpdated Today - UpvoteDownvoteShare Job
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Reporting to the SVP, Sales & Client Management, the Director, Group Medicare Sales, is an integral member of the leadership team-driving BCBSMA's purposeful re-entry into the Group Medicare Advantage Market.
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About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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Assist patients with other eligibility programs, such as Medicare Part D Prescription Drug Coverage through research using Medicare’s website; and assist patients with the Medicare and MassHealth Open Enrollment periods.
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6+ years of direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required. Reporting to the Provider Performance Senior Manager/Operations Director/Operations Senior Director (Market President), the Provider Performance Manager ensures the effective management of the performance outcomes of the provider network.
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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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Coordinate or prepare annual Medicare Cost Report and maintain related records as required by Medicare regulations. Responsible for administration of Vantage Point commercial insurance policies.
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Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories.
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Reporting to the Associate Vice President of Value-Based Care, the Senior Risk Adjustment Program Manager will identify improvement opportunities and provider performance trends, direct the implementation of new technologies, manage vendors, and deliver routine executive and board-facing reporting on the performance of Medicare risk adjustment programs.
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Strong working knowledge of Case-Mix, Federal Medicare PPS process, and medical reimbursement. Work today, get paid today! Now hiring: (RN) MDS Coordinator. Now Hiring: (RN) MDS Coordinator. NOW HIRING: (RN) MDS Coordinator.
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