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We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
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Channel Marketing Director, Medicare Advantage - Hybrid. The Marketing Director will be responsible for leading the channel marketing team that supports the Cigna Medicare Advantage (MA) business.
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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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FTE: 1.000000 Shift: Shift 1 Work schedule: Monday-Friday Job Summary: Ensures accurate and complete coding of diagnoses that fall into the Hierarchical Condition Category (HCC) model, as necessary for Medicare Advantage plans and other risk-adjusted (RAF) guidelines, through clinical assessment of the patient chart & preparation of that chart for the provider, active education, provider training/communication, and monitoring for effectiveness.
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Experience with geriatric patients in value-based care contracts such as Medicare Advantage. Foundational to this transition is moving the business model from primarily Fee-For-Service (FFS) to FFS plus Value Based Care (VBC.
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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service ( FFS ) , Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System ( T-MSIS ) , or Prescription Drug Event ( PDE ) data.
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A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.
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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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Non-profit accounting preferred and knowledge of OPO Medicare Cost Report is required. Monitors legislation, regulations and policy statements that impact the organ procurement organization and transplant center Medicare reimbursement.
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Summary The Risk Adjustment Reporting & Analytics Manager is an opportunity to lead complex analytics projects and initiatives for Cigna's Medicare Advantage Risk Adjustment business. Summary The Risk Adjustment Reporting & Analytics Manager is an opportunity to lead complex analytics projects and initiatives for Cigna's Medicare Advantage Risk Adjustment business.
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Act as physician leader for the Plan for all Medicare Advantage quality management functions: analyze information to develop interventions that improve quality of care and outcomes, with a focus on at risk performance (ex: STARS, State-based programs, VBC.
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The WellBe care model is a Physician Led, Advanced Practice Provider driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients.
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Our 1,000+ clinicians serve more than 1,500 senior living community partners across 33 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans.
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Requirements:Coding certification required through AHIMA or AAPC (at least one of the below):Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Certified Coding Specialist for Providers (CCS-P)Registered Health Information Management Technician (RHIT)5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred.
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medicare advantage jobs Company: Cmp Jobs
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