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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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Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial.
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The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services.
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AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Pharmacy Prior Authorization Coordinator II in Miami or Gainesville, Florida. Certified Pharmacy Technician (CPhT) - Certifications - Pharmacy Technician Certification Board (PTCB), Pharmacy Technician Certification (CPhT) - Certification - National Healthcareer Association (NHA.
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Verifies Medicare/Medicaid patient eligibility and obtain initial authorizations for services. We provide skilled nursing, physical/occupational therapy, personal care and other home health services in Miami Dade and Monroe County, with the highest regard for quality of care and respect for our patients.
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Possesses at least 6+ years recent experience with Medicare and/or Medicaid Part A, B, & DME claims, coding, and reimbursement procedures, service and coverage policies, coordination of benefits, as well as provider and beneficiary eligibility.
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A minimum of 2 years' experience in a Medicare, Medicaid and other State & Federal healthcare programs. Jessie Trice Community Health system is seeking a qualified, board certified Pediatric Dentist that will provide primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence.
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Follow Up and Denial reps should maintain a daily average of 50 claims (minimum) per day on Managed Care, Medicare & Medicaid, and all other payers. Prior relevant work experience in AR/Medicaid/Commercial health insurance processes.
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The incumbent conducts highly complex analysis while leading the design, planning, and production of reports and analysis related to quality performance metrics and outcomes measures for the University of Miami Health System / Immunology & Histocompatibility Laboratory, that are defined by internal parameters to meet the mandates by state and federal programs, inclusive of the Centers for Medicare and Medicaid Services.
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Familiarity with Medicare, Medicaid, and commercial health insurance rules and regulations is a plus. Job responsibilities include analyzing contracts and medical claims, performing legal research, and conducting administrative appeals for complex denials of hospital claims.
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The Clinical Care Manager is involved in care management services inclusive of Special Needs Members (SNP), Seniors and Persons with Disabilities (SPD), private insurance, Medicare, and state’s Medicaid programs.
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Excellent understanding of Medicare and Medicaid regulations, OASIS, and PDGM. Medicare Home Health leadership experience as an RN. If you are an experienced Director of Nursing / DON, Director of Patient Care Services / DOPCS, Director of Clinical Services / DOCS, Clinical Manager, Clinical Supervisor, or Patient Care Manager with Home Care experience, then you need to read on.
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Familiarity with pharmacy benefit, specialty payer landscape and reimbursement pathways (commercial, Medicare, Medicaid). The position is a remote/field-based role that leads FRM’s across the country.
$201,025 - $260,150Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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As a Darwin Claims Analyst, you will be responsible for implementing new and updating existing benefit plan setups for Medicare, Medicaid, Commercial and Employer clients. Pharmacy Benefit Manager System Configuration setup and maintenance for pharmacy benefits, networks and pricing for Medicare, Medicaid, Commercial and Employer groups.
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Extensive knowledge with Govt related regulations National, State, and Local, for Medicare, Medicaid,Champus/Tricare. BA preferred or equivalent Medicare or Medicaid Billing experience required.
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medicare medicaid jobs in Miami, FL
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