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This position will support Medicare Risk Adjustment activities including ACO REACH, MSSP and Medicare Advantage activities. Serves both internal and external customers, identifies opportunities for improvement throughout the Medicare risk adjustment process.
$100,000 - $231,500 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Job Description :Audit & Reimbursement III - Medicare Cost Report AuditLocations: This is a virtual position; the ideal candidate will live within 50 miles of an Elevance Health PulsePoint location.
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The Senior Director will provide\ strategic leadership to the HHC System Credentialing Verification Organization (CVO), Medical Staff Office (MSO) and Provider Enrollment teams (PE). The Senior Director will have oversight for credentialing and provider enrollment and medical staff functions for all HHC employed providers, assuring timely enrollment of all HHC facilities and medical groups with payers.
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Advanced in Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software) Proficient in Medicare/Medicaid regulations, health care terminology, and various software packages and applications such as Medicare Cost Report software (HFS Software.
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External Relations Serve as a spokesperson for HHC on matters related to Think 100%, including engagement with the media, partners, and coalition allies. Throughout our history, HHC has mobilized hundreds of thousands of young BIPOC voters across seven election cycles, produced HOME (Heal Our Mother Earth) – the first climate album to move over 60,000 people to action in support of the Clean Power Plan in 2014, and led the first protest in New Orleans after Hurricane Katrina and continually partnered with local organizations for annual commemorations.
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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.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Perform complex Medicare cost report audits, serving as an in-charge auditor assisting other auditors assigned to the audit. Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement.
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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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The wellness premium applies only to the Blue Cross Blue Shield Hospital Medical Group #14000 plan for non-Medicare eligible active and retired members, non-Medicare-eligible members on LOA or COBRA, and non-Medicare-eligible spouses on active or retired contracts.
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Assist in the preparation of the Medicare & Medicaid cost reports for all McLeod entities including hospitals, home office, rural health clinics, home health, hospice and other facilities as required.
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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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Under the direction and supervision of the licensed staff the Care Coordination Assistant performs the following activities and processes: post acute care coordination (SHF HHC DME Hospice etc.
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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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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 5 days ago - UpvoteDownvoteShare Job
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Work with Finance and Billing to establish a system to approve all pre-transplant charges for inclusion on the Medicare cost report. Completes Medicare time studies in a timely manner for inclusion on the Medicare cost report.
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hhc medicare jobs Title: representative Company: Metroplus Health Plan
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