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Providing sound, practical judgment in the interpretation and application of relevant laws and regulations, including the Anti-Kickback Statute, the Beneficiary Inducement Statute, Medicare/Medicaid, False Claims Act, Stark Law, HIPAA and state health information privacy laws, and marketing and advertising laws applicable to the marketing and promotion of medical products.
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Knowledge of Medicare Advantage, and experience leading an operational unit. 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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Work you’ll doProvide expertise on Medicare (preferably Claims) Healthcare AnalyticsDevelop healthcare data analysis visualizations and support data linkages to those visualizationsPerform data modeling, database development and managementDevelop user stories and mockups for data visualizationPerform coding and testing of data visualizations using open source or visualization packages such as Tableau.
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Signify Health is hiring board-certified physician assistant/physician associate (PA) contractors to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members.
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Providence Health Plan caregivers are not simply valued - they're invaluable.
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Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQNational Committee for Quality Assurance, and ERISEmployee Retirement Income Security Act of 1974.
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This individual should have both deep and broad expertise within the Medicare Advantage sector, with a minimum of five years’ experience leading large-scale member acquisition centers (licensed agent headcounts in the 100+ range.
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Providence Health Plan is a non-profit offering equitable health care to all lines of businesses inclusive of Public Programs: Medicare and Medicaid; Commercial: Large Group, Small Group and Individual Fully Insured (FI) Plans as well as Administrative Services Only (ASO.
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In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare and other populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care.
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A minimum of 2 years experience in hospital billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO's and PPO's required.
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Serving millions of Medicare and Medicaid patients, Optum is the nation’s largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family. For NPs: Graduate of an accredited master’s degree in Nursing (MSN) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP.
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Utilizes guidelines for skilled documentation following standards established by The Center for Medicare and Medicaid Services (CMS), Medicare Administrative Contractor Local Coverage Determinations (MAC LCD) and HumanGood.
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Knowledge: Knowledge of health insurance as it relates in Medicare, Medicaid and Commercial lines of business. Understanding of health care operations in various clinical settings: primary care, specialty, hospital, ambulatory and post-acute.
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RequirementsBilingual (English/Spanish) is highly preferredProven experience as a Medical Lien Negotiator within a legal settingStrong understanding of medical billing, lien resolution, and negotiation techniquesWell-versed in statutory liens (Medicare, Medicaid, ERISA, etc.
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Experience with market access and knowledge of US market access dynamics including IRA, Medicare, Medicaid would be appreciated. Experience with market access and knowledge of US market access dynamics including IRA, Medicare, Medicaid would be appreciated.
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medicare job in Salem, OR
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