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AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. The TOC Coordinator may be responsible for other Transition of Care activities, including support for members transitioning from acute inpatient BH care to community-based services, transitions from intensive BH service programs to community care, and referrals to the Health Coordination team, Behavioral Health, Disease Management, Medicare/SNP, Pharmacy, and assistance with outreach to Resource Organizations as necessary.
ExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Tracks and maintains consumer enrollment and eligibility with Medicare, Medicaid and other medical insurance plans. Maintains electronic clinical Master Registry and organizational filing systems, client documentation(s) report(s) and memos to include updating of consents to meet HIPAA compliance and agency quality assurance are met.
$45,000 - $47,940 a yearFull-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Understanding of Medicare, Medicaid, commercial, and patient reimbursement/billing, and HIPAA. EMS|MC offers full-service revenue cycle management solutions and is the largest billing services provider focused exclusively on emergency medical services in the U.S. We offer services from software to hardware to billing services and everything in between.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Under the Centers for Medicare and Medicaid Services (CMS) Federal Vaccination Mandate, all health care workers must be fully vaccinated against COVID-19 or have an approved medical or religious exemption from receiving the COVID-19 vaccination.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Prepare case files for presentation to Provider Operations Leadership and Credentialing Committee in order to satisfactorily meet all standards as required by HMSA policies and procedures, State and Federal regulatory requirements and all relevant accreditation standards pertaining to the credentialing for HMSA providers in all lines of business including commercial, Medicare, Medicaid and ACA products.
ExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Previous medical billing and/or accounts receivable experience. Use of basic office equipment such as computer, fax, printer, copier. Accurately document each call and the outcome in Rescue Net Billing in an efficient, clear, and concise manner.
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Assures compliance with all mandated regulatory reporting requirements including but not limited to Centers for Medicare and Medicaid (CMS), Provides infection prevention and control programs/services that add value and integrated with departmental, facility, Medical Center and organizational business and clinical goals/objectives.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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The Finance team develops revenue and risk score projections for bids and budgets, evaluates changes in Medicare and Medicaid regulations and payment models, monitors and reports on risk adjustment data submissions, and supports HQRI operations.
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Verify insurance, Medicare, Medicaid and Medicaid Room and Board. Must have three (3) years of related experience with Medicare, Medicaid, and commercial insurance preferably in a hospice environment.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Knowledge of Medicaid, Medicare, Third Party payer requirements, SNF/ICF, ICD-10 and DRG’s. Knowledge of Medicaid, Medicare, Third Party payer requirements, SNF/ICF, ICD-10 and DRG’s. Experience with computer based applications, preferably in SMS and/or EPIC systems.
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Responsible to support the development and implementation of required activities to ensure compliance with Centers for Medicare and Medicaid Services (CMS) requirements and mandates, that ensures compliance with Medicare contracting and reporting requirements.
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Providing sound, practical judgment in the interpretation and application of relevant laws and regulations, including the Anti-Kickback Statute, the Beneficiary Inducement Statute, Medicare/Medicaid, False Claims Act, Stark Law, HIPAA and state health information privacy laws, and marketing and advertising laws applicable to the marketing and promotion of medical products.
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Experience in Utilization Management (UM) with knowledge of Medicaid and Medicare programs. CNSI and Kepro are now Acentra Health! Psychiatrist (MD/DO) or Health Services Provider in Psychology (HSPP) (Ph. D.) with a current non-restricted license to practice medicine by the Board of Medical Examiners in the State of Indiana.
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Develops strong relationships with key internal and external stakeholders including but not limited to key departments, providers, Community Based Organizations, Community Health Centers, Hawaiis Med-QUEST Division, Department of Health, Centers for Medicare and Medicaid Services, and others.
ExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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This job will deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits.
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medicare medicaid jobs in Honolulu, HI
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