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Applies the Centers for Medicare & Medicaid National Coverage Determination (NCD) 310.1, Routine Costs in Clinical Trials, to determine if the study is a qualifying clinical trial with therapeutic intent, diagnosed disease, Medicare benefit category, and deemed status or seven desirable characteristics.
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Providers to process prior authorization (PA), and drug benefit exception requests on behalf of Aetna as the client and in accordance with Medicare Part D CMS Regulations. The CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of as the client and in accordance with Medicare Part D CMS Regulations.
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An Enrollment Specialist is a member of the Patient Engagement Specialist (PES) team, telephonically educating and enrolling patients in a Medicare-sponsored care coordination program designed to help the patient better manage their chronic illnesses (diabetes, high blood pressure, COPD, etc.
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Assists RCM in billing issues as it relates to Medicare and Medicaid provider numbers. Responsible and leads key projects related to licensing/Medicare/Medicaid processes, adverse sanctions, and disclosures of ownership related to applications.
Starting at $100,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Wellpoint, formerly Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. 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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ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services.
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Organizing, coordinating, and performing the reimbursement function for Piedmont Healthcare and system entities, including the preparation of entity Medicare/Medicaid/ Tricare cost reports, surveys, audits, appeals, budget and planning in an effort to assist management in operational and compliance decisions.
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The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to local Medicare patient populations at our innovative network of neighborhood primary care centers.
$215,000 - $245,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Review healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) Your goal everyday is to develop claims editing logics that promote payment accuracy and transparency across Medicaid, Medicare, and commercial lines of business.
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It is highly preferred that the individual have an understanding of Medicare billing rules and functional knowledge of essential National Coverage Decisions and the new CMS Clinical Research Policy.
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The Medicare Cost Report & Reimbursement Manager will act as the day-to-day leader of Northside Hospital’s Government Reimbursement Function. This position will require leadership skills and will also require maintaining a high degree of knowledge on Medicare Cost Report instructions, data inputs, and changes to Medicare and Medicaid regulations related to Reimbursement.
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Serves as a subject matter coding expert on Medicare Risk Adjustment and additional clinical specialty-based coding. This position also supports accurate Medicare risk adjustment reporting and potentially healthcare exchanges.
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Keywords: Admissions RN, Hospice RN, Hospice Nurse, Hospice Registered Nurse, Nurse, nursing, hospice, homecare, home care, healthcare, health care, home health, med surg, Oasis, ER, Emergency Room, ICU, intensive care unit, RN case manager, Medicare, visit nurse, admission nurse, skilled visit, case management, r.n., rn, acute care.
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Handles the end to end process of Medicare Secondary Payer (MSP) files, processes personal injury (PIP) and short term disability claims. Handles the end to end process of Medicare Secondary Payer (MSP) files, processes personal injury (PIP) and short term disability claims.
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For a list of all applicable centers, see Role Description: The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to local medicare patient populations at our innovative network of neighborhood primary care centers.
$215,000 - $245,000 a yearFull-timeExpandApply NowActive JobUpdated Today
medicare job in Atlanta, GA
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