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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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Monitors for inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), the Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS.
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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.
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Monitor Case Mix Index (CMI) scores, looking for potential risks and/or changes that may affect Medicaid reimbursement. MDS Coordinator Assistant. The MDS Coordinator completes MDS for all residents according to OBRA and PPS guidelines.
$45 - $55 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Demonstrated understanding of insurance, Medicaid, Medicare billing requirements. State License with one or more of the following licenses: Licensed Clinical Social Worker (LCSW), Licensed (Clinical) Professional Counselor (LPC or LCPC), or Licensed Marriage and Family Therapist (LMFT.
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Deep knowledge and understanding of revenue cycle, collections and payment posting, medical billing, Medicare and Medicaid, and third-party payers. As our medical biller, your daily duties will include maintaining and submitting billing, appealing denied claims, and posting payments.
$23 - $25 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Implements activities supporting the Health Equity enterprise-wide efforts for NCQA, DHCS, Centers for Medicare & Medicaid Services (CMS) and other regulatory agencies as they align with priorities set by leadership.
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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), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe.
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Well-versed in statutory liens (Medicare, Medicaid, ERISA, etc.) Are you an experienced Medical Lien Negotiator seeking an opportunity to excel in a dynamic and prestigious personal injury law firm.
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Featured in CNN, Forbes, The Wall Street Journal, Daily Journal, The Advocate. TorkLaw, a recognized industry leader in providing unparalleled legal advocacy for our clients, is seeking a talented and motivated individual to join our team as a Medical Lien Negotiator.
$40,000 - $65,000 a yearFull-timeWork from homeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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SUMMARY: Under the direction and supervision of the Clinical Manager/Director, the RN Assessment / MDS Coordinator is responsible for conducting and coordinating the completion of the resident comprehensive assessment which includes the Minimum Data Set (MDS), and for tracking, and transmitting all data including the RUG levels to the Centers of Medicare & Medicaid Services (CMS.
$40.55 - $60.29 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage & eligibility, completes assigned registration financial clearance work lists activities, obtains insurance authorizations for scheduled & unscheduled Hospital services, and secures inpatient visit notification to payors.
$17.46 - $26.24 an hourPart-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Experience working with PACE and Medicare/Medicaid programs strongly preferred. Record and reconcile PACE Medicare and Medicaid payments. Assist Finance Manager with annual Medicare Part D Bid process, by collecting and presenting supporting data.
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Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. We are one of only two certified Pediatric ICUs in Orange County and the only hospital in Fountain Valley and Huntington Beach with a Level III Neonatal ICU. We're proud of the efforts of our physicians, nurse and staff who strive to provide you with the best care possible.
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The incumbent independently performs a wide range of functions related to the Medical Center's Regulatory Compliance Program including the submission of necessary documentation to regulatory/accreditation entities such as the California Department of Public Health (CDPH), The Joint Commission (TJC), and Centers for Medicare and Medicaid (CMS.
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medicaid job Company: Association For Community Affiliated Plans in Orange, CA
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