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Great Place to Work®Most Loved Workplace® Forbes Best-in-State EmployerMedicare Specialist (Remote)PRIMARY PURPOSE: To coordinate, analyze and facilitate Medicare Compliance and Medicare Set-Aside (MSA) functions within the assigned team.
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Communicates and advises appropriate internal and external stakeholders on Medicare Compliance and Medicare Set-Aside (MSA) matters including, but not limited to, lien negotiation efforts, MSA submissions and/or general information.
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Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses’ analysis. Maintains thorough understanding of service and products offered by Medicare Compliance department.
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Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required. Experience with Medicare issues preferred.
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Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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And it means working in an environment that celebrates diversity and is fair and inclusive. It’s having support for your mental, physical, financial and professional needs. ExperienceFour (4) years claims management experience or equivalent combination of experience and education required.
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The Medical Director, Medicare (MDM) provides organizational leadership in the Population Health (PH) Medicare Line of Business (LOB) under the direction of the Medicare (MC) CMO, in areas such as care management, utilization management/medical cost, quality results, provider performance and policy, to advance ACFC and Medicare Plan objectives and improve the health of our member population.
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This includes analyzing Medicaid capitation rates, overseeing the actuarial components of the Medicare Advantage bid pricing, and analyzing historical and emerging experience to identify opportunities to improve financial outcomes for CareOregon, its provider network, and its members.
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Knowledge of managed care, health plan operations, and regulatory and compliance requirements for Medicare D-SNP and Covered California. Under the direction of the Senior Director of Commercial Products, the Director, Product Implementation - Medicare & Commercial, will lead the annual product renewal and implementation projects to support the Medicare D-SNP and Covered California lines of business.
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Minimum seven (7) years' Medicaid, Medicare, Medicare Stars, Medicare Risk Adjustment, and Government health insurance related data analysis experience required. The Medicare Data Analyst Lead supports the Medicare Risk Adjustments, Stars, Performance Analytics or Medicaid team by performing insightful analytics, leading data integration efforts, and communicating findings to internal and external business partners.
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Stay informed about industry developments, emerging trends, and best practices in Medicare Part D and actuarial science, and provide thought leadership and strategic insights to the organization.
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The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed Consent Forms, Clinical Trial Agreements, and other relevant study-related documents to create a coverage analysis/billing guide.
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Our Medicare Sales Field Agent sells individual health plan products and educate beneficiaries on our services in a field setting. About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.
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These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ability to directly impact your own income potential.
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Officially we title this job a BOM or Business Office Manager, but in other centers it may be called a Medicare / Medicaid Biller or Accounts Receivable Coordinator or even a Financial Services Rep.
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Title: medicare Company: Assurance Independent Agents
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