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We own nursing homes, health plans for Medicare beneficiaries living in long-term care facilities, as well as divisions offering psychiatric care, home health, hospice, rehabilitation and specialty pharmacy services.
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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), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Ensure a consistent customer experience across our Company's division and functional areas and share key learnings to support customer needs by effectively communicating and collaborating with the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.
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Oversee extracting and collecting diagnosis data from claims systems, submitting this data in the form of Medicare Risk Adjustment Processing System (RAPS) files to CMS in a timely manner, and oversee the RAPS record error correction processes.
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Experience working in a value-based care, senior care, and/or Medicare managed care. + Support pharmacy performance improvement activities and align pharmacy services with improvement quality metrics and Medicare part D performance.
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Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VA Community Care Network), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.
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Participates in HumanGood provided Medicare and MDS webinars and education in order to keep current with RAI updates and evidence-based practices in the Post-Acute Long-Term Care settings. Verifies billing aspects of Medicare are thoroughly documented and reimbursed as appropriate.
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Provides direct supervision to LVN MDS Nurse. The Terraces of Boise, named by U.S. News & World Report “Best Independent Living” and “Best Continuing Care Retirement Community for 2023-2024” is hiring an MDS Coordinator-RN.
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With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years.
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The Terraces of Boise, named by U.S. News & World Report “Best Independent Living” and “Best Continuing Care Retirement Community for ” is hiring an MDS Coordinator-RN. Reviews pertinent hospital records to determine the most appropriate MDS ARD, projected HIPPS codes and identify the most appropriate principal diagnosis for skilled coverage.
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ECP launched as an internal start-up in 2020 with a wholly owned Medicare Shared Savings Program ("MSSP") Accountable Care Organization ("ACO") spanning four states. Holds accountability for establishing and delivering on a clearly defined performance plan for Evolent Primary Care and sub-plans for each business segment (MSSP, Medicare Advantage, and Commercial payer partnerships.
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Fill out provider applications for contracted payers-Blue Cross products, Blue Shield products, Medicare, Medicaid, Tricare, ACN, etc. MINISTRY/FACILITY INFORMATION Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities.
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An active, independent California Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Clinical Psychologist Residence in Idaho 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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Our providers work primarily within nursing homes or assisted living communities with residents who are enrolled in special Medicare Advantage plans. If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who enjoys working with the aging population, consider joining the TruHealth team.
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Scope is Healthcare Quality Improvement and Reporting spanning Medicare Risk Adjustment, Stars/Quality, and Interoperability related projects with organizational and enterprise impact. 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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medicare job Title: visiting nurse association in Eagle, ID
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