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Description : JOB SUMMARYThis 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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Create and implement marketing plans and budgets that align with the channel's goals and objectives, as well as the regulatory and compliance requirements for Medicare Advantage products.
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Major duties of an Appeals Coordinator include providing comprehensive and efficient analytical support to prepare Medicare cost report appeal filing and associated supporting documents, communicating with hospital clients, MACs, and Provider Reimbursement Review Board (PRRB) staff, preparing and editing correspondence of legal documents, calendar management, docket management, and maintaining files.
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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. 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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The Health Quality and Stars team centralizes quality improvement and governance processes targeting Humana's Medicare Advantage members, and also manages compliant data submissions to CMS in adherence with the Stars Rating Program.
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Medicare Appeals Coordinator – Indianapolis or Milwaukee. You’ll get the opportunity to engage in complex matters including defending healthcare providers against allegations of fraud as well as pursuing Medicare reimbursement appeals in federal court.
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Great Place to Work®Most Loved Workplace® Forbes Best-in-State EmployerMedicare Specialist (Remote)PRIMARY PURPOSE: To coordinate, analyze and facilitate Medicare Compliance and Medicare Set-Aside (MSA) functions within the assigned team.
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Global IT Category Strategy ConsultantWork Location: Global Elanco Headquarters - Greenfield, IN - Hybrid Work Environment, or UK - Hook OfficeAs part of the Elanco Global IT Procurement team, the Global IT Category Strategy Consultant is a critical interface with indirect procurement peers and IT business stakeholders to bring competitive advantage and innovation through marketplace category expertise, strategic sourcing and management of suppliers.
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Our network consists of a variety of payors, an accountable care organization (ACO), telemedicine, and Medicare advantage products. Our network consists of a variety of payors, an accountable care organization (ACO), telemedicine, and Medicare advantage products.
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Audit & Reimbursement Lead- Medicare Cost Report Appeals. Under direction of management, the Audit and Reimbursement Lead will provide technical leadership, supervision and coordination on contractual workload involving the Medicare cost report and Medicare Part A reimbursement.
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Exclusive Insurance Payor Access: Only SonderMind provides complimentary credentialing for both traditional Medicare and Medicare Advantage plans, including Humana and United Healthcare.
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As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Pallet jack, material handling, rf scanner, shipping & receiving, Forklift certified, Forklift, Packaging, Packing, Cherry picker, Production, Inventory, Heavy lifting, Picking, Order picking, Stand up, Forklift operating, Reach truck, Sit down forklift, Sitdown, Stand up forklift, Forklift operation, Warehouse inventory.
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Field Sales Agent*Very Competitive Pay and Sales Incentive Programs*CommuniCare Advantage, a member of CommuniCare Health Services, is currently recruiting an experienced Sales Representative for our Medicare Advantage plan.
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Knowledge of all pertinent federal and state regulations, filing and compliance requirements, both adopted and pending, affecting employee benefits programs, including ERISA, COBRA, FMLA, ADA, Section 125, workers' compensation, Medicare, OBRA, and Social Security and DOL requirements.
$75,376 - $133,415 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Baker Tilly US, LLP (Baker Tilly) is a leading advisory CPA firm, providing clients with a genuine coast-to-coast and global advantage in major regions of the U.S. and in many of the world’s leading financial centers - New York, London, San Francisco, Los Angeles and Chicago.
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medicare advantage jobs Company: Capital Markets Placement in Indianapolis, IN
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