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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
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In addition, this role leads value-based contracting (VBC) workflows to include evaluation and forecasting of full and partial risk arrangements between NeueHealth affiliated providers and payors from multiple LOBs (Commercial, Medicare Advantage, Medicaid, etc.
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Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), FSA, foreign claims, outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, and Medicare Secondary Payer (MSP) by calculating benefit due to approve or deny, based on SPD.
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The Medical Director, Medicare (MDM) provides organizational leadership in the Population Health (PH) Medicare Line of Business (LOB) under the direction of the Medicare (MC) CMO, in areas such as care management, utilization management/medical cost, quality results, provider performance and policy, to advance ACFC and Medicare Plan objectives and improve the health of our member population.
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Audit & Reimbursement III- Medicare Cost Report Appeals. Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement.
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Utilizes appropriate coding guidelines to assign ICD and CPT codes; conforms to applicable Medicare, Medicaid and other third-party payer guidelines to ensure receipt of accurate reimbursement; works in collaboration with the Clinical Documentation Improvement team to ensure accurate DRG assignment and works closely with management to resolve problems and meet deadlines.
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Demonstrate fundamental knowledge of various relevant insurance programs/products (e.g., HPN; United Healthcare; Medicare; Medicaid) Demonstrate understanding of vehicle equipment operation and maintenance (e.g., identify/report equipment issues and problems) -Demonstrate understanding of relevant medical equipment operation and maintenance (e.g., EKG; PFT; DPN; VPT; ABI; Holter.
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The CMO Group Medicare will be an integral part of the GM Leadership team and will be responsible to lead and provide thought leadership internally and externally on behalf of Group Medicare.
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Our Medicare Sales Representatives sell individual health plan products and educate beneficiaries on our services in a field setting. 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 Part D - Submit Medicare Part D disclosure letters to client as per Benefit Timeline. Assist bSwift team with set-up of client web site as directed by Benefits Operations Manager.
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Advanced knowledge of an acute and chronic care medical setting, medical terminology and the psychosocial and economic effects of illness and/or trauma upon the patient and their support systemAdvanced knowledge of managed care and public programs such as those funded by Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
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Compliance oversight for “Schedule A” request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA. Compliance oversight for “Schedule A” request from carriers, Form 5500, Medicare Part D Disclosures and CMS Reporting, HIPAA and ERISA and COBRA.
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Well-versed in statutory liens (Medicare, Medicaid, ERISA, etc.) TorkLaw, a recognized industry leader in providing unparalleled legal advocacy for our clients, is seeking a talented and motivated individual to join our team asa Medical Lien Negotiator.
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Regulatory Standard Compliance: Coordinates compliance with all hospital departments for the regulatory agencies such as Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), Department of Health and Hospitals (DHH), The State of Louisiana, etc.
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medicare job in Metairie, LA
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