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Maintains in-depth knowledge of CalOptima Health's DHCS and/or Centers for Medicare & Medicaid Services (CMS) data reporting requirements and builds reports for DHCS accurately and on a timely basis.
$115,353 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Coordinates the vending of professional translation and review services in one or more languages (Arabic, Chinese, Farsi, Korean, Spanish, and Vietnamese) · Assists in completing and/or responding to regulatory agency reports (Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), etc.
$30 - $40 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The ideal candidate will have expertise in both front-end and back-end development, with a particular focus on developing applications that support healthcare operations, report writing, and data analysis using Power BI. Experience with CMS (Center for Medicare and Medicaid) and Value Based Care programs is highly preferred with an emphasis on knowledge with claims data (CCLF) and electronic medical records (EMRs.
$50 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
$173,200 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Life insurance, annuities, disability insurance, medical long term care, homeowner’s insurance, auto insurance, umbrella liability policies, and public insurance programs such as Social Security, Medicare, and Medicaid will be explored.
Part-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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The Care Consultant Sr. for Provider Success is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business) to assess and deploy appropriate interventions to drive success in value-based care.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and other Medicaid, Medi-Cal and other regulatory audits.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs required. Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department and will be responsible for monitoring the GARS member and provider mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe.
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Manager will lead analysis and evaluation of Market Access contracts (Commercial, Medicare and Managed Medicaid, Health Exchanges) including analysis of utilization and market share data for rebate agreements.
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Knowledgeable in managed care, Medicare, Medicaid regulations, Model of Care and NCQA Population Health requirements. An in-depth understanding of managed care, Medicare and Medicaid regulations, Model of Care and NCQA Population Health requirements are necessary.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Sending correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections. Researching validating and reconciling enrollments from the error reports and CMS (Center for Medicare and Medicaid Services) daily files.
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Experience as a medical coder/biller with a working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement. As a Reimbursement Specialist/Medical Collector, you will be responsible for accurate and timely claims reimbursement activities, including working with home infusion IVIG, TPN, and Medicare claims.
$31 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Assists in completing and/or responding to regulatory agency reports (Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), etc.
$40.36 an hourExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Knowledge of Medicare, Medicaid Billing/Collections, HCPC, CPT, ICD-9 coding. Knowledge of Medicare, Medicaid Billing/Collections, HCPC, CPT, ICD-9 coding. Posting payments and identifying problems at payment posting.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Minimum of two (1) years' experience working with Medicare and Medicaid insurance as well as commercial insurance plans and benefits (PPO, HMO, POS, EPO, Indemnity) strongly preferred. This role requires basic computer skills, high speed internet (minimum of 40 GB) and a private workspace, and secure transportation to DaVita facilities to perform the duties of the job.
$28 an hourFull-timeRemoteExpandApply NowActive JobUpdated 30 days ago
medicare medicaid jobs in Irvine, CA
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