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Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage. Review provider documentation of diagnostic data from medical record to verify that all Medicare Advantage and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company.
$25 - $35 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Health care regulatory knowledge focusing on Fraud, Waste, and Abuse; knowledge of Value-based care, Medicare Advantage Organizations, ACO REACH and MSSP programs is required. Juris Doctor and a member in good standing of a state bar association (or Registered In House Counsel with the CA Bar.
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Working knowledge of lnterQual IS-SI, Milliman and Robertson Managed Care Guidelines, Erickson Life Skills (Age Competencies}, Medicare Part A and Part B, Medi-Cal, NCQA, HEDIS and other criteria as identified by the Quality/Case Management Department.
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Maintains understanding of various payers and Medicare pre-authorization processes. JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk.
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This role will provide regulatory guidance on various healthcare-related issues with a focus on Anti-kickback Statute (and related state statutes), Stark Law, Civil Monetary Penalties Law, and develop compliant solutions to to facilitate and promote One Medicals business objectives, including value-based care, care coordination, and clinical integration.
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The incumbent must acquire an advanced understanding of payer requirements for the lab's top payers, which include Medicare, Blue Cross, Aetna, Cigna, United Healthcare, Tricare, and Medicaid. Advanced understanding of payer requirements for Medicare, Medicaid, and HMOs/PPOs.
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Since its inception in November 2019, Better Health has gained Medicare licenses in 46 states, 11 Medicaid licenses, and preferred national provider contracts with Oscar Health, UHealth, Humana.
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Graduate of an approved curriculum in Speech Language Pathology, is able to practice unencumbered, is in good standing with all regulatory agencies and licensing boards, has working knowledge of Medicare and other payer sources, full knowledge of residents rights, exudes professionalism in presentation and able to work on multitasks at the same time.
$55 - $70 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Establishes appropriate internal controls to support SOX and Model Audit Rule requirements for the Medicare Finance & Risk Adjustment MEGA. Oversees the Fee-For-Service hospital cost reporting for Medicare and Medicaid.
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Reviews, edits, processes and submits electronic and hardcopy claims to various payers (Medicare, Medicaid, Managed Care and Private Insurance) for FQHC (Federally Qualified Health Centers) and FFS (Fee-For-Service) reimbursement to ensure accuracy of payment entries and completeness of charge captured information.
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Our previous interns have copy edited articles and written about a wide range of topics, including Medicare Advantage plans, Native Hawaiian healing practices, and the best time to stretch. Our services have been positively reviewed by Good Morning America, The New York Times, NBC News, AARP, and many others.
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Completing all assigned/required training, while staying up to date on developing clinical knowledge, specifically ECG rhythm interpretationFollowing all company, HIPAA, and Medicare policy and proceduresComplete a training period, a ramp-up stage and then you go into your regular shift with 4 day/ 10 hour shifts.
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Conduct legal research on federal and state healthcare laws, regulations, policies, and requirements (e.g., Medicaid, Medicare Advantage, HIPAA, anti-kickback) Familiarity with Medicaid and Medicare Advantage program requirements, healthcare privacy guidelines, and compliance and ethics programs.
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We have one of the most state-of-the-art and comprehensive skin-based service lines including laser, light, radio-frequency, reconstructive and cosmetic surgery techniques, Medicare-approved surgery centers and a full-service dermatopathology laboratory.
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An active, independent California Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Clinical PsychologistResidence in CaliforniaThough we do not require our providers to see Medicare patients, you must not have opted out from MedicareHave access to reliable and stable internet while working remotely; experience with Google Suite is a plus.
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