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The AVP will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position.
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Knowledge of local external payor sources (Medicare, Medicaid, TRICARE, Health Net, ); knowledge of payor source implications on discharge plan, resources and placement options to maximize patients' successful disposition.
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Maintains understanding of various payers and Medicare pre-authorization processes. JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk.
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Maintains compliance with applicable regulatory agency requirements, including The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), State and Local agencies, Occupational Safety and Health Administration (OSHA), etc.
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Ensure all provider enrollment data is properly controlled and tracked to ensure applications are approved or denied within standards of timeliness established by department and Centers for Medicare and Medicaid Services (CMS.
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Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid, Marketplace and Medicare lines of business, including but not limited to fee-for service, capitation and various forms of risk, ASO, etc.
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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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Follow and implement wage and hour laws, federal, state and local laws and regulations, Medicare, and legislation affecting employment; ensure compliance with all laws and regulations including Teammate Health and Safety Training Program and Mission Veterinary Partners healthcare clinical and safety standards.
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We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad.
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Must have strong experience and understanding of care coordination and Medicare. Cannot be excluded from participation in any state or federal programs such as Medicare or Medicaid. You will ensure a smooth on-boarding credentialing, training, and start of new Providers and their implementation into Skilled Nursing Facilities and other healthcare settings.
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Greater than 3 years of experience in providing Medicare yearly exams under a Global Risk/Medicare Advantage Model. Complete Medicare yearly wellness exams for seniors and provide limited primary care.
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In compliance with the emergency regulation issued by the Centers for Medicare & Medicaid Services (CMS) dated November 4, 2021, and company policy, Our nurse residency program gives you the confidence and skills you need to set you up for success.
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CenterWell Senior Primary Care has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience.
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Assists with data entry and the timely reporting of required data to The Joint Commission and the Centers for Medicare and Medicaid Services. Experience and/or level of competency: At least 5 -7 years of relevant behavioral health experience in quality, compliance and risk management, healthcare improvement, patient safety, regulatory and accreditation.
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The Cash Posting Representative is responsible for properly and accurately posting payments received from Medicare, Medicaid, commercial Insurance Companies and Patients, recording and reconciling these postings monthly against a bank statement or similar document.
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medicare job in Las Vegas, NV
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