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Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan.
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Extensive knowledge of CMS claims data, in either the IDR or CCW environment or with CMS Limited Data Set (LDS) Analytic files is required including Inpatient, Outpatient, Skilled Nursing Facility, Home Health Agency, Hospice, Carrier, Durable Medical Equipment, Prescription Drug Event (PDE), and Medicare Advantage Encounter claims.
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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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Exclusive Insurance Payor Access: Only SonderMind provides complimentary credentialing for both traditional Medicare and Medicare Advantage plans, including Humana and United Healthcare.
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Sage Health builds enriching neighborhood health centers that are easy to access, provide or arrange for all of our patients’ healthcare needs, and partner with Medicare Advantage plans that fully cover primary care.
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Channel Marketing Director, Medicare Advantage - Hybrid. The Marketing Director will be responsible for leading the channel marketing team that supports the Cigna Medicare Advantage (MA) business.
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Thoughtful client matching and dedicated coaches to grow your practice: We help you get paired with individuals who are ideal clinical matches so that you can control and personalize your caseload, and a dedicated coach to help you help your clients, no matter what your specialty, from pediatric to geriatric mental health, trauma, anxiety or addiction, we help you help others.
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Must be fully licensed by the State Board to provide therapy independently and without supervision (e.g., LPC, LCSW, LMFT, or LP). Free and stress-free credentialing with major insurers: We have streamlined the credentialing process and handle all the hard stuff for you so that you can expand your practice by accepting insurance from major payors in your state in weeks, not months.
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Some awareness or knowledge of health/care reimbursement systems (Medicare Advantage, Commercial payer, Medicaid and CMS regulatory rules) Annually: Successful completion of PCC Assessment of Critical Skills, Passing score on inter-rater reliability.
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Monitor and analyze health policy developments, with a focus on those affecting commercial insurance, including Medicare Advantage. Monitor and analyze health policy developments, with a focus on those affecting commercial insurance, including Medicare Advantage.
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Being a SonderMind Psychiatric Nurse Practioner means you can:Flexibility: Have an office-based psychiatry practice, practice telemedicine, or have a hybrid practice while enjoying the freedom to set your own working hoursExclusive Insurance Payor Access: Only SonderMind provides complimentary credentialing for both traditional Medicare and Medicare Advantage plans, including Humana and United Healthcare.
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Send referrals/communicate with in-network vendors for coordination of post-acute levels of care such as Home Health, DME, IV infusion, SNF, Sub-Acute and Acute Rehab. The Patient Care Coordinator is responsible for overseeing the management and coordination of care for the acute inpatient population.
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Bonus points if you have familiarity with Medicare Advantage, Commercial, and Medicaid value-based care models and STARS/HEDIS quality measures. Sparks Group's health care partner is seeking a Temporary Data Entry Analyst to join their Provider Networks Team. In this role, you will play a crucial role in supporting our success and performance in various health plan value-based contracts, including Medicare Advantage, Commercial, and Medicaid.
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Recent projects include assessing the performance of strategic initiatives and business areas, refreshing the Medicare Advantage growth strategy, and identifying improvement opportunities for a key business function.
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Experience working with the Centers for Medicare and Medicaid Services (CMS) Bachelor's degree in Healthcare, Science, Public Health, Policy, or Administration. You’ll also broaden your expertise in problem management, strategic planning, reviewing contracts, and more.
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medicare advantage jobs in Washington, DC
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