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Clinical Description: The primary function of the HEDIS Retriever - Seasonal is to conduct onsite abstraction of services from medical charts in compliance with HEDIS/QARR, Medicare Advantage Star measure specifications.
$2,024 a weekFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Bonus PointsCertified Risk Adjustment Coder (CRC) or similar certificationExperience coding in multiple different Electronic Medical Record (EMR) systems. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment team.
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Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina Medicare and Medicaid on early recognition and timely routing of member complaints.
$189,732.18 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Inpatient/Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
$76,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Review the components of the Medicare Periodic Interim Payments (PIP) such as Disproportionate Share (DSH) and Low-Income Patient (LIP) percentages, Indirect Medical Education (IME), Capital payments, utilization, case-mix-index (CMI) and rate factors.
$62,941 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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AAPC Certified Outpatient Coder (COC®0 or AHIMA Certified Coding Specialist (CCS®) credential is a plus. AAPC (formerly the American Academy of Professional Coders) Certified Professional Coder (CPC®) or the American Health Information Management Association (AHIMA) Certified Coding Specialist – Physician-Based (CCS-P®) credential required.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.
$93,000 a yearExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Requirements: 2 years of Home care CHHA experience 1 year or more of Supervisory experience Ability to educate and motivate staff Good communication skills (written, verbal, oral) Knowledge of Medicare conditions of participation BSN (Masters preferred) NYS RN valid license NYS RN registration Valid driver’s license and ability to provide own transportation during working hours for the purpose of making home visits.
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External reviewers include New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement Organizations. Reviews information available from Medicaid, Medicare, other payers, and/or professional medical organizations regarding benefit levels and medical necessity criteria.
$93,000 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Account Specialist is responsible for identifying prospective members who do not have health insurance, determine the appropriate plan for the individual or family and enroll them into one of the health programs offered by Healthfirst such as Medicaid, Child Health Plus (CHP), Essential Plan (EP), Qualified Health Plan (QHP), Medicare or Complete Care. Customarily and regularly works away from Healthfirst's place of business.
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Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or equivalent certification through AHIMA and/or AAPC is required. Experience with Medicare, Medicaid and third-party payer coding and billing requirements.
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Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required. VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Edgewater, New Jersey.
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In-depth knowledge of all Fidelis Care products, including "metal" products offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA and HARP. Ability to answer product feature and benefit questions; compare and contrast Fidelis Care products and provider network of competing plans in assigned territory.
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Ensure timely and accurate processing of hospital claims, correspondence, and Call Tracking tickets according to 1199 Summary Plan Description (SPD) guidelines, member benefits and eligibility parameters, coordination of benefits (COB), regulatory and pre-authorization requirements, Medicare National Correct Coding Initiative (NCCI) rules, provider and repricing network contract terms and timeframes, and the Fund's departmental policies.
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Join our team at VillageCare as a Full Time UAS RN Assessor where you will play a crucial role in conducting comprehensive assessments for potential enrollees in our Medicare and Medicaid programs.
$110,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago
coder medicare jobs in New York, NY
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