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The DVBC manages value-based membership growth through various enrollment levers such as; aged-in member conversion, the Medicare Annual Enrollment (AEP) Period, member voluntary alignment, acquisition membership pull through, and new provider/de-novo membership ramp.
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Meet with eligible participants with the goal of enrollment and presenting product information for Medicare Advantage HMO, Medicare Advantage PPO, Medicare Supplement, or stand-alone Medicare prescription drug plans or other services and products for the Government Markets segment.
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Experience with Medicare Advantage STARS or Risk Adjustment. Works to develop and deliver high impact interventions, supporting content development and practice transformation embedded capabilities to significantly improve provider performance that drive cost of care and improve HEDIS/Stars where applicable.
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The AVP will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position.
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Maintains understanding of various payers and Medicare pre-authorization processes. JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk.
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Participates in the development of the annual strategic marketing/ community engagement plan to achieve annual enrollment targets. Assist in the development and administration of the PACE marketing budget, in cooperation with the Marketing and Enrollment Supervisor and Executive Director.
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Knowledge of HMO, PPO, POS, Medicare and other Commercial Insurance DME Regulations and guidelines. Assist with special projects as determined by DME Manager or Director. The DME Authorization Coordinator will provide DME operational support to ensure DME, Orthotics, supplies etc., provided to patients meet insurance billing requirements.
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An active, independent Florida Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPC) Residence in Florida Though we do not require our providers to see Medicare patients, you must not have opted out from Medicare Have access to reliable and stable internet while working remotely; experience with Google Suite is a plus.
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Licensed Practical Nurse (LPN) or Licensed Vocational Nurses (LVNs)Bilingual fluency in Spanish and EnglishExperience working in managed careKnowledge of Medicare/Medicaid regulationsPrior authorization and utilization experience.
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Leads Operations, plus matrix responsibility for other functional teams including but not limited to Billing and enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider Call Center, Provider Data Operations, and IT.
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As the hub for all cancer research activities, this office supports all aspects of research including but not limited to trial feasibility, activation, recruitment, and enrollment into Phase I-IV clinical trials; enhancing the opportunities for treatment options for patients in the Tampa Bay area.
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Ensure Medicare beneficiaries accurately understand the product choices available to them, the enrollment process (eligibility requirements, Medicare review / approval of their enrollment application, timing of ID card receipt, etc.
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Knowledge of Medicare, Medicaid, Private Insurance Reimbursement, and HCHCP. Proficient in computer applications (excel, access, word, and eCW) Knowledge of accounts receivable, FQHC, billing practices, regulations, CPT-4 and ICD-10 Codes.
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Job Title: Medicare Part D Agent Remote JobLocation: RemoteDuration: 11+ MonthsPay rate: 16/hr on w2 Job Description Hours of Ops: During Training – 8:00am – 5:00pm EST is open 7 days a week, 8am to 8pm Eastern Standard Time. However, you will only work 8 hour shifts a total of 5 days a week.
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UT reflects this vibrancy; with 24 consecutive years of enrollment growth UT boasts 260 student organizations, a multicultural student body from 50 states and more than 100 countries, and "Top Tier" ranking in U.S. News and World Report.
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medicare enrollment jobs in Tampa, FL
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