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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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Instruct patient and family members on proper use of equipment such as wheelchairs, braces, walkers, crutches, canes, and other prosthetic/orthotic devices Policies: Completes all clinical documentation following agency protocol and Medicare/Federal guidelines.
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The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services.
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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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Assesses, via electronic systems, patient’s insurance plans and benefits, such as MassHealth eligibility and Medicare benefits and facilitates coordination with Patient Financial ServicesPrepares, explains to patients, and documents delivery of the Medicare Important Message and Medicare Outpatient Observation Notice.
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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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About the roleThe Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work with management to meet communicated single and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing Risk Adjustment processes.
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Senior R programmer with RWD experience and required experience in CMS data (Medicaid, Medicare, etc). Must have hands-on RWD/RWE experience with CMS data, large-scale administrative claims data sources (e.g., MarketScan, Optum, Medicare LDS SAF, Komodo claims), and EHR.
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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. This is NOT a remote / 'work from home' position.
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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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We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. 1 year of enterprise host systems administration experience, host configuration management, and production support.
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Minimum of one year paralegal/legal assistant experience, preferably in healthcare environment or experience in Medicare or Medicaid provider enrollment or private payer enrollment/credentialing.
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Familiarity with mental health issues, HIV/AIDS, and state and federal laws regarding disability benefits (SSI, SSDI, OHIPP, ADAP, Covered California, Medi-Cal, Medicare, etc.) Helps clients apply for public disability benefits such as SSI, SSDI, and CAPI as well as address other health insurance and related issues including Medicare and Medi-Cal. Advocates for clients throughout the claims process, negotiating with SSA, disability analysts, Medi-Cal, and Covered California as needed.
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Lake Ridge Care Center is a Medicare/Medicaid-certified facility offering 24-hour skilled nursing care, on-site rehabilitation, and restorative nursing programs. At Lake Ridge Care Center, youre not just starting a job; youre joining a caring community committed to excellence and support.
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We CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.
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medicare job Title: decision support analyst Company: Highmark Health
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