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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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Advocacy – Leading voice with Administration officials to improve federal rules and regulations affecting Medicare, Medicaid, Duals, and CHIP. Work in close partnership with lobbying team to support congressional education and engagement, including federal lobbying activities on Capitol Hill, as well as with state officials focused on Medicaid solutions.
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Supports compliance with clinical lab regulatory standards such as Centers for Medicare and Medicaid Services (CMS), Clinical Laboratory Improvement Amendments (CLIA), College of American Pathologists (CAP), and other external agencies overseeing clinical laboratories.
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Supporting Commercial, MA, Medicaid, Medicare and Medicaid Dual Eligible provider contracting of ancillary and ancillary facility providers across all lines of business including preparation of Single Case Agreements.
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Knowledge of health care, managed care, Medicare or Medicaid. We are seeking candidates who reside in northwestern Illinois (region 1) near the Iowa/Wisconsin border (i.e. Cook, Lake, McHenry, Kane, Dupage, and Will counties.
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Ensure compliance with coding guidelines, regulations, and payer requirements, including CMS (Centers for Medicare & Medicaid Services) and commercial insurance policies. Utilize Epic electronic health record (EHR) system and 3M coding software to assign appropriate ICD-10, CPT, and HCPCS codes.
Starting at $28 - $32 an hourExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Experience with Medicare, Medicaid and Retail/Small Group Risk Adjustment process. Job SummaryThis position is responsible for the overall management and implementation of various initiatives including, but not limited to, Risk Adjustment Programs, Accountable responsibilities include the overall development, refinement, maintenance, monitoring and oversight of Medicare, Medicaid and Retail/Small Group risk adjustment initiatives and operations.
Full-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Understands Medicare, Medicaid, and commercial insurance. The Pre-Certification Specialist is responsible for processing referrals for services and obtaining needed authorizations from the patient’s payor source.
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This key leader position provides strategic leadership, value-based guidance, sets operational direction and performance expectations for both leaders and associates in Humana's sales operational areas including Medicare Advantage, Prescription Drug Plans, Medicare Supplement, Medicaid Managed Care Plans and Individual Major Medical insurance plans.
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In addition, facilitate applications for programs including, but not limited to, Medicare, Medicaid (Public Aid), Circuit Breaker, Senior Care, and Ryan White. Gathers data and completes required analysis at the request of outside audit staff during audits by Medicare, Medicaid, and Blue Cross and reports the impact of audit adjustments to management.
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The National Payer Relations Manager (NPRM) is pivotal in supporting the US Market Access Department's mission to ensure patient access to best-in-class technologies and products for Advanced Wound Management, including Grafix, Oasis, and PICO. The NPRM will focus on government payers (such as Medicare, Medicaid, and Veterans Affairs) and commercial payers (including United, Anthem, Cigna, Aetna, Blue Cross, etc.
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Minimum of two (2) years billing experience; experience with Medicare/Medicaid billing strongly preferred. Research, edits/corrects and transmits any claim rejected by the claims editing software in order to submit them timely to the appropriate intermediary, which include but are not limited to: Medicare, Medicaid and MCOs.
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Complete understanding of all levels of MCO/Medicare/Medicaid reimbursement issues and their impact on business performance; identify potential obstacles and lease with Market access to resolve effectively.
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Officially we title this job a BOM or Business Office Manager, but in other centers it may be called a Medicare / Medicaid Biller or Accounts Receivable Coordinator or even a Financial Services Rep.
Full-timeExpandApply NowActive JobUpdated 25 days ago - UpvoteDownvoteShare Job
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Experience preferred in conducting or knowledge of hospital and/or physician diagnosis and procedural coding and billing requirements as they relate to Medicare and Medicaid. The Research and Compliance Analyst will assist in the administration of the Enterprise Risk Management Program that includes Corporate Compliance Program, HIPAA Privacy Office, and Research.
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medicare medicaid jobs in Chicago, IL
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