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We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
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Additionally, complete annual Medicare Cost Report schedules and post weekly DCF third-party collections, reconciling them to weekly reports processed. Additionally, responsibilities involve completing Medicare Cost Report schedules, posting Department of Children and Families (DCF) collections, and addressing assorted issues with payers and service providers, with potential involvement in supporting other areas of the business office as needed.
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Assist members obtain appropriate community resources, e.g., elder care, Medicare, Medicaid, Faith Based Organizations, local foundations. As a Social-Worker you will work with a variety of internal and external sources, including member self-service, Care Managers, the member contact center, third party vendors such as Health Dialog, wellness/health fairs and GuideWell Enterprise Channels.
$62,500 - $101,500 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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The Billing & Reconciliation Representative 2 determines discrepancies between company records and the records of Center for Medicare and Medicaid Services. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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Knowledge of UB04 / CMS1500 claims, ICD-9, ICD-10/ Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission, Medicare and Medicaid. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market.
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Conducts critical communication with patients or legal guardian facilitating the understanding of and obtaining signature on multiple consents, assignment of benefits, and notices including but not limited to Consent for Treatment and Conditions of Admissions, Advance Directives, HIPAA, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance, ABNs, and MSPQ, prior to services being rendered.
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Manage and monitor completion of periodic code updates (e.g., ICD-10, CPT, HCPCS), provider contracts annual updates (e.g., yearly rate escalators), Medicare fee schedules, price updates, etc. The Configuration Analyst is also responsible for performing analysis on claim payment, provider contracting, benefits administration, and or other system issues and developing possible solutions as well as addressing the issue.
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Trilogy Home Healthcare Coral Springs - SPEECH LANGUAGE PATHOLOGIST, SLP PRN Medicare Home Health Visits. Trilogy Home Healthcare Coral Springs - SPEECH LANGUAGE PATHOLOGIST, SLP PRN Medicare Home Health Visits.
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Many of our skilled nursing facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Signature HealthCARE is a family-based healthcare company that offers integrated services in 10 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care, and telemedicine.
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Experience in health care models including Medicare Advantage Programs and provider risk models is a plus. Experience using tools in at least one cloud computing platforms such as Snowflake (highly preferred), Amazon Web Services, Microsoft Azure, or Google Cloud Platform preferred.
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Working knowledge of Medicare claims, episodic and conditional groupers and identifiers, Medicare risk adjustment, patient diagnoses, network analysis and cost-model development. Working knowledge of Medicare claims, episodic and conditional groupers and identifiers, Medicare risk adjustment, patient diagnoses, network analysis and cost-model development.
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Experience working with third-party payers, such as VA, Medicaid, Medicare Advantage, and Worker’s Compensation. Utilize coding systems (CPT, ICD-10) to guarantee meticulous billing and collections.
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Experience with RIsk Management / Medicare Advantage required - 2 clinical days per week; the remainder of time is administrative Provideprofessional guidance and oversight to physicians and mid-level providers to achieve excellence in care delivery and a superior patient experience, promoting value-based, comprehensive care.
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Experience with pharmacy benefit management operational standards and processes, Medicare Part D, and CMS regulations. Be an SME on all lines of business (Medicare, Medicaid, commercial, etc) and stay current with regulatory guidelines, ensuring testing complies with rules and regulations.
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Assist patients with the application of Medicare, Supplemental Security Income (SSI), social security card, change of status, or other benefit related to Social Security Administration (SSA). Duties and Responsibilities Assist patients with the completion of the applications for SNAP, Medicaid, Medicare Saving Program, or any other Government benefit program, based on the information they provide and with the submission of verifications and general information regarding the application process.
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medicare job in Miami Gardens, FL
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