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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System (T-MSIS), or Prescription Drug Event (PDE) data.
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Experience in the evaluation, assessment, analysis, or administration of CMS Program policy, including Medicare, Medicaid, CHIP, or Marketplace. Experience working with the Centers for Medicare and Medicaid Services (CMS) - Center for Program Integrity.
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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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CMMI was established by Congress in 2010 to identify ways to improve healthcare quality and reduce costs in the Medicare, Medicaid, and Childrens Health Insurance Program (CHIP) programs. ORAU is seeking a Fully Remote, Senior Advisor on Medicaid to work with CMMI as an ORAU employee.
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We are seeking a Criminal PROSECUTOR/LITIGATOR and Civil PROSECUTOR/LITIGATOR to investigate, prosecute and litigate Medicaid provider fraud as well as abuse and neglect of persons in residential facilities using a full array of civil and criminal remedies.
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Health care policy experience is required, preferred experience working in Congress or at the Department of Health and Human Services (HHS) or Center for Medicare and Medicaid Services (CMS) As a Health Policy Director, candidates will have critical responsibilities related to lobbying and policy strategy development and implementation on behalf of clients.
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As the Vice President of Payer Contracting Strategy within the Business Development team, you will lead and execute the Company's payer contracting strategy, including, but not limited to, Commercial, Medicare Advantage, and Medicaid plans, and oversee the development of new initiatives to enhance payer value and alignment for value-based care programs.
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JOB SUMMARY: The Medicaid Billing Specialist processes the Medicaid insurance claims by entering authorizations into the billing software and researching denied claims for the Fortitude DC/Spring Flats Services within the Homeless and Housing Services Department.
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Virginia Hospital Center was recently designated a Newsweek 2020 Best Maternity Care Hospital, received a 5-star rating from the Centers for Medicare and Medicaid Services (CMS) and once again named a Leapfrog Top Hospital in 2019.
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The new Magnet designation is in addition to several other prestigious recognitions which include: a five-star rating from the Centers for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation's highest performing hospitals, and among the top 10 Major Teaching Hospitals, an A for Patient Safety by The Leapfrog Group, the #1 hospital in the DC metro area by U.S. News & World Reports and being nationally ranked in gynecologic care.
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Establish regular communication and a working relationship with Medicaid MCOs for network development and to monitor performance, stay attuned to market changes and MCO and stakeholder managed care contract priorities.
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Five or more years of healthcare leadership and management experience with demonstrated ability in managed care contracting, practice transformation, Value based care performance tracking and systems change.
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Inova Fairfax Hospital is proud to announce that the American Nurses Credentialing Center (ANCC) awarded Magnet® designation, the most prestigious accolade for nursing excellence, to our hospital in December 2020.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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medicaid job in Washington, DC
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