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This position serves as the principal HMSA contact for prospective and current Oahu employers and members inquiring about small group health plans, individual plans, Medicare plans and USAble Life product options that are available through HMSA. This position supports HMSA's overall sales and service strategies.
$41,690 - $61,212 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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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Associate degree in medical billing/coding, health insurance, healthcare or related field preferred. 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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Experience:Prior HCC/HHS experience with Medicare Risk Adjustment with three (3) years’ experience in medical coding. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”The Capital BlueCross Government Programs Risk Adjustment coding position is a unique position that combines knowledge and experience in risk adjustment coding, Medicare and Government regulations, Medicare Advantage risk adjustment model, HHS ACA risk adjustment models, and RADV and HRADV experience.
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3 years HCC coding and/or coding and billing. 5 years HCC coding and/or coding and billing. Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making.
ExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Engages in RPM Coding educational meetings and annual coding Summit.
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Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements. Certified Coding Specialist (CCS.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Build partnerships and work within coding teams and internal partners critical to HCC coding. Maintains RPM coding accuracy and productivity requirements. Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals.
ExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Certified Risk Coder (CRC) In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
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Registered Health Information Technician (RHIT) Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.
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Certified Professional Coder (CPC) Assists with Regulatory Audits by performing first coding review and ranking of charts. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity.
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If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org.
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Participate actively and thoughtfully in multidisciplinary teams, drawing on your past experience with Medicare, epidemiological and health services research methodology, pharmacoeconomics outcomes research, and decision sciences.
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Provides subject matter expertise for one or more of the following: Risk Adjustment for CMS HCC Medicare Advantage and/or Medicaid (CDPS Rx, Milliman, Mercer), Quality (HEDIS / STARS) measure performance, Population Health including population segmentation, risk stratification models, disease management and case management performance tracking and analytics.
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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 job Title: field reimbursement manager Company: Amerisourcebergen Corporate
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