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Communicates and advises appropriate internal and external stakeholders on Medicare Compliance and Medicare Set-Aside (MSA) matters including, but not limited to, lien negotiation efforts, MSA submissions and/or general information.
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Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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Must meet Center for Medicaid/Medicare Services (CMS)-approved national certification requirements within the CMS timeline. Liberty Administrative Services, LLC treats all individuals equally without regard to race, color, religion, sex (gender identity, gender expression, transgender), sexual orientation, age, pregnancy, parenthood, marital status, national origin or ancestry, citizenship status, disability, military status, genetic predisposition or carrier status or any other impermissible factor according to applicable law.
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Extensive experience in healthcare contracting, with a critical understanding of PBMs, National Health Plans, Medicare Part D/B, GPOs, VA/DoD, Medicaid, and the evolving market landscape. Minimum of 12 years of pharmaceutical industry experience, with significant expertise in at least two of the following areas: Channel Strategy, Finance, Pharmacy, Pricing, Trade, or Market Access.
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Ensure a consistent customer experience across our Company's division and functional areas and share key learnings to support customer needs by effectively communicating and collaborating with the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.
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Knowledge of CRM tools (such as Salesforce, Dynamics CRM) is an advantage. Experience / education in risk management/safety is an advantage. Act as a solution specialist of the Bowtie Suite software, the bowtie method, barrier-based thinking, incident management methodologies and other related risk management topics.
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Providing sound, practical judgment in the interpretation and application of relevant laws and regulations, including the Anti-Kickback Statute, the Beneficiary Inducement Statute, Medicare/Medicaid, False Claims Act, Stark Law, HIPAA and state health information privacy laws, and marketing and advertising laws applicable to the marketing and promotion of medical products.
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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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Provide excellent service to assigned accounts; Sell PBC's Service Advantage ? Products in this portfolio include, but are not limited to, Pepsi, Gatorade, Tropicana, Frappuccino, Rockstar and Bang products.
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Job Summary: Under general direction of the Case Management Director, the RN Case Manager utilizes well-developed knowledge and skills in areas of utilization management, medical necessity, patient status determination, Medicare compliance, and revenue cycle; collaborates with the multidisciplinary patient care team for optimal patient care outcomes, discharge planning, and readmission prevention; and participates in ongoing assessment of systems and clinical care processes.
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Demonstrate the ability to operate each vessel or serve as a deckhand/operator in case of an emergency, which will be considered an advantage. Notify customers of freight delivery before the river barge arrives at the destination.
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Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC.
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Certifications in CCNA networking, Virtualization, or UNIX OSs an advantage) (M.S. an advantage) Oracle Senior Site Reliability Developer Juneau , Alaska Apply Now Customers rely on Oracle Cloud Infrastructure (OCI) to power their business as they tackle some of the world’s biggest challenges.
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5+ years of healthcare actuarial experience; Experience working with Medicare Advantage pricing and bid development. Experience certifying the Medicare Advantage Bid. Provide expertise and consultation to support the Medicare bid process and pricing strategy.
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In coordination with Outreach and Enrollment, Direct Health Benefits functions to screen self-pay patients for alternate resources and apply for Medicaid, Medicare, VA, HRSA, TSHIP, grants, and ACA.
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medicare advantage jobs in Juneau, AK
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