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Medicare Advantage and Medicaid (Dual Members) risk adjustment experience preferred. Experience with ACA Risk adjustment, Star, and Medicaid quality incentives preferred. Preferred Location: Hanover, MD.The Medicare Risk Adjustment Advanced Analytic Senior Is responsible for creating statistical models to predict, classify, quantify, and/or forecast business metrics.
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Responsible for leading all NCQA Health Equity Accreditation work for Humana's Medicaid markets. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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You'll assist residents of Virginia through the Medicaid, SNAP, and/or TANF application process and determine their eligibility for these services. Description & Requirements This is a fully remote position open only to residents of the Commonwealth of Virginia.
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Manager Data Analysis & Testing - Medicaid Segment. Bachelor's Degree in Computer Systems Analysis, Data Processing, Healthcare Informatics or Management Information Systems. Master's Degree in Management Information Systems or Healthcare Informatics.
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114th and Dodge in Omaha, NE.The Medication Access Coordinator role is designed for an experienced Registered Pharmacy Technician with retail pharmacy insurance experience or a Medicaid/Medicare/Private Pay Insurance professional with at a minimum one year of pharmacy Technician experience.
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Knowledge of Medicare, Medicaid, VA or Charity Care programs, or patient management and healthcare accounts receivable. Monitors all self-pay and Medicaid (MA) pending inpatient and observation patients daily to ensure active follow-up for insurance is in progress.
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Communicate with clients and Medicare and/or Medicaid contractors via telephone and email. Prepare Medicare and/or Medicaid cost reports utilizing specialized software to assist clients in obtaining appropriate reimbursement under federal and state regulations by required deadlines.
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Assist client with completing, applying for, and submitting Polk County Applications and Presumptive Applications for Medicaid. Work with Senior Outreach Counseling to complete intake process and funding resources-Obtain funding from Polk County obtaining Pre Authorizations, Elderly wavier (MCO’s case managers), and working with Aging Resources.
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Serves as a resource point for internal and external customers and Centers for Medicare & Medicaid Services (CMS) 2 years' experience with Medicare/Medicaid rules and regulations. Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) required.
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Knowledge of Medicare and Medicaid billing guidelines and regulations. The Billing & Accounting Specialist will be responsible for accurately processing billing documentation, handling claims, ensuring compliance with Medicare and Medicaid regulations, and assisting with accounting related tasks.
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Compliance: Ensure all billing practices comply with Medicare and Medicaid regulations, as well as senior living facility requirements. Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) certification.
Full-timeExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Lead Actuary - Medicaid Trend Quantification. Experience with Medicaid a plus. Become a part of our caring community and help us put health first. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
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Experience within Medicaid Management Information systems (MMIS), Medicaid or Commercial Health Care claims, Provider Management and/or Eligibility data. Are you a Medicaid Management Information System (MMIS) subject matter expert with technical/functional State Medicaid Data Warehouse Analytics experience.
$97,875 - $163,125 a yearFull-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Working knowledge of Medicare, Medicaid, MVA, Workers Comp and private insurance billing and reimbursement processes, legal requirements knowledge. Accurately bill Medicare, Medicaid, self-pay/uninsured, and commercial insurance, processing claims in accordance with payer requirements and organization policy.
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Acts as an advisor and consultant in the establishment of operational policies of the practice to include: (1) Purchasing and capital allocations; (2) Managed care plan participation; (3) Budget and practice expenses; (4) Medicare/Medicaid participation; (5) Billing and collection of professional fees; (6) Personnel management and related policies; (7) Risk management and quality assurance; and (8) Coding compliance.
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medicaid job in Des Moines, IA
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