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The incumbent will be responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process in medical and dental insurance plans, including but not limited to Medi-Cal, Medi-Cal Managed Care, Medicare, and commercial insurance.
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Handles walk-in or telephone inquiries and invites referral source to nursing center; completes inquiry electronic system for admissions, Medicare facts, and room rates; Gathers nursing information from e-discharge system, or floor nurse at hospital.
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Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), FSA, foreign claims, outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, and Medicare Secondary Payer (MSP) by calculating benefit due to approve or deny, based on SPD.
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Demonstrates knowledge of Hospice Medicare Benefit Program, including levels of care. RN Hospice Clinical Team Manager - Fresno, CA areaLucrative compensation package: Base + Bonus + Free Medical/Vision insurance, generous PTO and other outstanding benefits & employee perks.
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Work you’ll doProvide expertise on Medicare (preferably Claims) Healthcare AnalyticsDevelop healthcare data analysis visualizations and support data linkages to those visualizationsPerform data modeling, database development and managementDevelop user stories and mockups for data visualizationPerform coding and testing of data visualizations using open source or visualization packages such as Tableau.
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The ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations. The ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations.
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Leads and trains staff in standards of excellence as specified by Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Participates in The Joint Commission survey readiness as assigned.
$127,000 - $142,000ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Excellent knowledge of Case-Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required. Excellent knowledge of Case-Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required.
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Knowledge of Medicare, Medicaid and commercial insurance procedures required. We are seeking an Admissions Coordinator to join our team! Knowledge of Medicare, Medicaid and commercial insurance procedures required.
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Develop working knowledge of clinical quality measures (AMP and HEDIS) and Medicare Risk Adjustment (MRA). The analyst must work with the team to support various lines of payer business, Medicare, MediCal, Commercial, and Accountable Care Organization (ACO) as well as various provider specialty and groups.
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Exact job experience is considered any of the above tasks in a Medicare certified. Meet quality assurance requirements and other key performance metricsFacilitate resolution on customer complaints and problem solvingPays attention to detail and has great organizational skillsActively listens to patients and handle stressful situations with compassion and empathyFlexible with the actual work and the hours of operationUtilize company provided tools to maintain quality.
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The CRS manages the overall resident assessment process and tracking of all Medicare/Managed Care/Medicaid case mix documents in order to ensure appropriate and optimal reimbursement for services provided within the Care Center.
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Knowledge of financing mechanisms such as Medicare, Medicaid, and Prospective Payment. PACE staff are leaders in the “aging in place” industry and we have had the honor of serving Fresno, Bakersfield and Orange County seniors and their families/caregivers.
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Verifies method of payment for service (Medi-Cal, Medicare, private insurance, private pay, Healthy Families, etc.) This includes; providing excellent customer/patient services via phone and in person; referring callers to the appropriate departments; making appointments for patients according to established center protocols; assisting patients/clients with forms; pre-registration and eligibility/insurance verification.
$17 - $29.47 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Coordinates staffing and scheduling to meet census needs. Performs the Joint Commission Tracer field visits for staff team members. Coordinates with Intake Department to ensure timely response to new referrals.
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medicare job in Fresno, CA
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