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The Medicare Sales Representative II is involved with health education through the distribution of health ed. In addition, the Medicare Sales Representative II provides Facilitated Enrollment, helps facilitate the continuance of health insurance, and offers assistance with recertification.
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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.
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HCC Risk Adjustment Coders will be involved with activities of code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), and Medicare RADV (Risk Adjustment Data Validation.
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The Credentialing Coordinator is responsible for maintaining the confidentiality of all Medical Staff related information, organizing and preparing for committee meetings, and ensuring compliance with the Medical Staff Bylaws, accrediting and regulatory agencies (i.e., Joint Commission, Centers for Medicare & Medicaid Services, NCQA) in regard to credentialing while developing and maintaining a working knowledge of the statutes and laws.
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Position SummaryExperienced/career level position responsible for overseeing quality review audits of medical records coded by internal team (CDQA and Sr Analyst CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
$67,900 - $149,300Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Qualified candidates will be an experienced Clinician, RN with a Managed Care Plan background, experienced in MLTC and/or Medicare Advantage Plans, with an emphasis on Care/Case Management and Manager level experience.
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No more Medicare, Manager Care, gate-keepers, HMO’s, welfare, DRG’s, RVS codes, prior authorizations, PPO’s or other third party payers. In a given surgical office, the Physician is part of a team that includes not only the Clinical Staff, but Senior Counselors (non-clinical team members who meet with and educate patients on hair loss and hair restoration), Front Office Assistants, and the Office Manager.
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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.
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As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health's network includes over 27,000 primary care providers, specialists and participating clinics.
$90,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Medicare Sales Representative II provides greater access to health insurance, by providing education and assistance to Medicare individuals. Medicare Sales experience preferred.
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Our range of health services include home care, hospice and palliative care for adults and children, rehabilitation and nursing care at Menorah and Isabella Centers, and the research based MJHS Institute for Innovation and Palliative Care. We also offer Elderplan/HomeFirst: health plans for Medicare and dual-eligible individuals.
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Requires on-going knowledge of local and national resources, including but not limited to Social Security, Medicare, Medicaid, other HRA benefits, additional state/county programs and resources, and the ability to link callers to appropriate organizations for needs.
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About NYC Health + Hospitals. Knowledge of and practical application of Adult Learning Theory and instructional design principles. The Call Center Training Facilitator will be responsible for the onboarding of new hires, training of existing staff, residual, and advanced skill training.
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If appointed, you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid.
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Our previous interns have copy edited articles and written about a wide range of topics, including Medicare Advantage plans, Native Hawaiian healing practices, and the best time to stretch. Licensed pharmacists or recent PharmD graduates who are looking to gain writing experience should consider applying to our Freelance Writer, Pharmacy position.
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medicare job Company: Capital Markets Placement in New York, NY
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