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At United HealthCare Medicare & Retirement, we serve the fastest growing segment of our nation‘s population - 50 and older. This will include training on the Medicare business, to serve Medicare eligible members and prospects looking for health care coverage.
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Serve as the Primary Business Consultant/Representative to other areas regarding coding, coding guidelines, and various Medicare reimbursement methodologies such as MS-DRG, OPPS, IPPS, APR-DRG, and Fee Schedules.
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Ability to apply knowledge of the United Network for Organ Sharing (UNOS)/ Organ Procurement and Transplantation Network (OPTN), the Centers for Medicare and Medicaid Services (CMS) Condition of Participation (CoP) for Transplant Programs, and the Joint Commission governing organ donation and transplantation in the.
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Department Specific FunctionsImplements goals and objectives for hospital development in accordance with our strategic plan, Association for Organ Procurement Organizations (AOPO) standards and Centers for Medicare and Medicaid Services (CMS) guidelines and ensures these goals and objectives are met.
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The incumbent serves as the primary medical cost analytics consultant to our Finance, Clinical, Operations, and Specialty Care leadership and will make data-driven strategy recommendations in the Medicare Advantage and healthcare industry.
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Stay current on AHCA regulations and Medicare COP’s guidelines. Stay updated on Medicare, Medicaid, Managed Care, and other private insurance guidelines. Demonstrate expertise in compliance with local, state, and federal laws related to home health regulations and Medicare requirements.
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Assists in and takes the ownership of the unit Manager with the coordination of all regulatory audit activities for the Underwriting and Financial Department, including DFS Market Conduct Exams, Medicare ACR audit and OPM audit.
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Our client, a provider of Health, Dental, Vision, Medicaid, and Medicare Healthcare service plans in the state of California with 4.7 million members and $22.9 billion of annual revenues, seeks an accomplished Product Manager.
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This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for accounting.
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These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. About Us About onehome: onehome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes.
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Experience working with seniors a plus, as is a general understanding of Medicare Advantage. Meet with seniors and groups in their homes, workplaces, and places of worship to share about CCMC’s ability to meet their care needs.
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Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for accounting.
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Experience with, or willing to learn, Medicare regulations and related reimbursement practices related to hospice and long-term care. Bachelor's degree, preferred -or- 5+ years' experience in hospice, home healthcare sales, or marketing, in lieu of degree.
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Position Summary: The SSBCI (Special Supplemental Benefits for the Chronically ILL) Specialist plays an integral role in the product development of Medicare Advantage (this includes the evaluation of SSBCI benefit.
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Knowledge of: Healthcare law, Medicare and Medicaid/MediCal regulations as they relate to hospice and palliative medicine. - Conditions of Participation in the Medicare Hospice Benefit.
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