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If employed at one of our senior living communities that receives Medicare or Medicaid funding, team members must not be considered an “Excluded Party” as defined by the U.S. Department of Health and Human Services, any state Medicaid Programs, and any additional federal and state government contract programs.
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Experience or understanding of Medicare and Medicaid claims, ICD10 codes, HCPCS, Diagnosis Related Groups (DRG). 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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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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Experience in health care, health plans, Covered California, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect.
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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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DESIRED ATTRIBUTESCPA, MHA or MBA. Experience with Medicare/Medicaid cost reporting 4 - 6 years as a Sr. Reimbursement Analyst or similar position(s). Knowledge in the following areas:Reimbursement functions: Subject matter expert on CMS cost reporting, disproportionate share (DSH), Uncompensated Care, Bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, Ohio Medicaid, HCAP, UPL and Franchise Fee programs.
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The analyst monitors and reviews existing and new Center for Medicare and Medicaid Innovation (CMMI) Government Programs whether for the hospital system, the ambulatory providers, or the CIN, to understand the risk components and partners with the Chief Population Health and Growth officer and interdisciplinary team to assess feasibility and requirements for participation.
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Strong understanding of federal and state regulatory bodies, government payers including CMS (Medicare Parts A, B, D, and Medicare Advantage), Medicaid (Medicaid FFS and Medicaid health plans), HRSA (340B), and state healthcare programs, as well as commercial payers.
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Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
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1+ years of experience in medical records coding (HCC Coding) with knowledge of Medicare, Marketplace, and Medicaid risk adjustment is required. CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, RHIT, RHIA or CPMA. CRC is required within the first year of employment.
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MI Registered Nurse (RN) or Licensed Practical Nurse (LPN) Required. Pine Ridge is a 111-bed Skilled Nursing Facility that is Medicare and Medicaid Certified with 33 private rooms and 39 semi-private rooms.
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The facility sits on Hansen Care Park's beautiful, wooded property with private and semi-private rooms, spacious shower and restroom facilities, beauty salon and barber shop services, walking paths, state of the art rehabilitation areas for those who need physical, occupational or speech therapy and cozy places to relax throughout the facility.
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QUALIFICATIONS & EXPERIENCE REQUIREMENTSGraduate of an accredited school of nursing; RNValid RN license in the state employedThree years of experience in a long term care environment preferredExperience with the MDS/RAI process and/or case management preferred JOB RESPONSIBILITIESThe MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is responsible for accurate and timely completion of mds assessments and coordination of the RAI process.
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Current certification as a Nurse Practitioner by the American Nurses Credentialing Center (ANCC) or National Certification Corporation (NCC), or an equivalent Medicare/Medicaid approved certifying body, or be actively seeking certification and obtain the same in the specialty area requested within 24 months of privileges being granted at Salem Hospital.
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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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medicare medicaid rn or jobs Title: coordinator Company: Opco Skilled Management
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Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.