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Medicare Documentation Requirements o The PPS Program Coordinator serves as a clinical resource for PPS regulations and compliance, coding and billing related to the IRF-PAI, and CMS documentation requirements.
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Maintains all relevant logs, meeting minutes and listings pertaining to CMI, Medicare, as directed or as indicated in policy, procedure, or protocols. Utilizes RAI manual information for accurate and complete coding of all MDS information that is attached to his/her unique login and password within the MDS software system.
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Experience with compliance auditing, facility and physician coding/billing practices, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred. Experience with analyzing and/or auditing Revenue Cycle functions; including, but not limited to, ICD-10, CPT, and HCPCS coding accuracy, Medicare policy requirements, and any other operational workflows affecting billing accuracy for hospital or physician claims.
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Our expertise includes: the quantification of financial exposure through analytic and statistical methods; prescription drug claims submission and payment; pharmacy benefit administration; Medicare Part D compliance; and the preparation of expert and consultative reports shared with prosecutors or used in commercial litigation.
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Responsible for review clinical documentation to abstract and/or validate CPT and ICD-10 coding medical services. Minimum of two (2) years billing experience; experience with Medicare/Medicaid billing strongly preferred.
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WellBe is a Physician Led, Advanced Practice clinician driven, geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This position requires high degree of NCQA HEDIS and Medicare Star Rating knowledge, ability to prepare and present program results to senior management, analyze large volume of data, develop reporting, and function within a highly matrix environment.
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And associated billing documentation (such as encounter forms, EOBs, Epic billing data and related documents) for coding and billing accuracy. Identifies trends or patterns of questionable coding and billing practices for the System and reports issues to Manager.
$35 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Verify that documentation adheres to established coding guidelines, such as ICD-10 and CPT, and compliance with healthcare regulations (e.g., HIPAA, Medicare, Medicaid). Maintain current knowledge of CMS policies and coding applications for CPT, ICD-10, HCPCS, and other applicable coding standards for medical claims.
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Monitor guidelines for Medicare and insurance coding and billing related to eye exams and related covered services to optimize revenue in compliance with the law and guidelines. LensCrafters is the largest optical retailer in North America with 1,000+ stores and as part of an eyewear industry leader, Luxottica, our higher standard of quality has made LensCrafters a leader in vision care for over 35 years.
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Stay current with medical coding guidelines and industry updates. Minimum of 3 years progressive experience in behavioral healthcare billing; both Medicaid, Medicare, and MCOs and commercial payers; behavioral health preferred.
$50,000 a yearFull-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Related experience in physician and hospital inpatient/outpatient medical billing, reimbursement, chart review, coding compliance, medical office or patient accounts, rehabilitation, clinical trials coding/documentation requirements, home health/hospice, practice management and physician revenue cycle and strategy consulting is a plus.
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The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting. Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) is required.
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Evaluate coding and documentation to identify recommendations for provider improvement. Assist in providing coding knowledge to providers and billing departments as needed. Certified as a CPMA.
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This role involves the execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government paid programs such as Medicare, Medicaid, Federal Employees Program, and TriCare.
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Best Practice Management Monitor guidelines for Medicare and insurance coding and billing related to eye exams and related covered services to optimize revenue in compliance with the law and guidelines.
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coding medicare jobs in Skokie, IL
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