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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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Excellent knowledge of Case- Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. Facilitates accurate determination of the Assessment Reference Date that accurately reflects the patient’s care needs and captures all resources utilized to ensure appropriate payment by Medicare/Medicaid and insurance programs.
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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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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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Florida plans include: Medicare, Medicaid, RR Medicare, Tricare, Florida Blue, United, Oscar, Cigna, Physicians Care Network IPA, West Florida, etc Texas plans include: Medicare, Medicaid, RR Medicare, Tricare, BCBS, United, and 2 different PPN plans Adheres to all company policies and procedures.
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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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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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1+ years of experience with long term care services and support, Medicaid, or Medicare. Licensed Master's Social Worker (LMSW), Licensed Professional Counselor (LPC) and/or Licensed Bachelor Social Worker (LBSW) OR RN in the state of Texas.
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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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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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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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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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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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Evidence required of a current negative tuberculin skin test or x-ray or receive TB testing at the date of orientation. with or without assistance Climbing Stooping (bend at waist) Hand/finger dexterity Occasionally (2%-33%) Distinguish smell/taste Rarely (1% or less) N/A Dayton, OH Well help you put your passion for patient care to work.
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medicare medicaid rn or jobs Title: coordinator Company: Wallingford Nursing Rehab
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