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Strong knowledge of healthcare regulations, compliance requirements, and industry standards related to Payor operations (e.g., HIPAA, HITECH, CMS regulations). Stay informed about healthcare regulations, compliance standards, and industry mandates affecting Payor operations, such as HIPAA, HITECH, CMS regulations, and state-specific requirements.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits.
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Very familiar with the art of building websites, CMS, DAM, Analytics, CDPs and crafting a best-fit solution using these technologies. Has good understanding of marketing automation technologies like Marketo, Salesforce Marketing Cloud, Eloqua, or similar and its role in the end to end customer life cycle.
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All work carried out in accordance with the rules, regulations and coding conventions of the American Association of Professional Coders (AAPC) ICD9 (and ICD10 when implemented), AMA CPT and CMS coding guidelines.
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Close clinical gaps to improve CMS STAR ratings/HEDIS measures. Board Certification (Board Certified Pharmacotherapy Specialist, Board Certified Geriatric Pharmacist) preferred. The Clinical Pharmacist is accountable for closing payer clinical care gaps, providing medication therapy management (MTM) for high risk patients, and providing physician and patient support.
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Extensive experience with Digital Experience Platforms (DXP) or Content Management Systems (CMS). Manage the implementation of needs for Optimizely's content management system (CMS), ensuring components, features and the user experience align to business across various channels.
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Net Framework 4.7, PeopleSoft, Mulesoft, Sitecore/CMS. Net Framework 4.7, PeopleSoft, Mulesoft, Sitecore/CMS. Extensive experience with Microsoft Azure and supporting services (DevOps, Kubernetes, etc.
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The Sr. Grant Administrator will be responsible for the pre and post award management of a portfolio of grants and contracts. The Sr. Grant Administrator will be responsible for the pre and post award management of a portfolio of grants and contracts.
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Licensed Nursing Home Administrator (LNHA) Needed for a Renovated 206-bed Skilled Nursing & Rehab Facility in Providence, Rhode Island! Elmhurst is a beautiful and updated nursing facility with a warm and friendly staff.
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Prior experience of providing MTM action plans for patients and providers in ambulatory care settings required. Document communications with physician offices and patients regarding pharmacy recommendations in appropriate EHR & care management systems.
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Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC.
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Proficiency in digital marketing tools and platforms, including content management systems (CMS), email marketing software, social media management tools, and analytics platforms. Serves as the content editor for the University’s Vision 2030 website and news site’s digital presence.
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Reporting to the SVP, CFO of the Health Care Delivery Segment (HCD), the Executive Director, Accountable Care Finance will lead financial operations and be a strategic partner to the President, CVS Accountable Care. CVS Accountable Care partners with health systems to enable their participation in CMS programs such as ACO REACH and Medicare Shared Savings Program (MSSP) as well as assuming risk with Medicare Advantage plans.
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To assist an Administrator, Environmental Protection (DEM), in the planning and administration of a statewide environmental regulatory program consistent with the jurisdiction of an assigned DEM functional unit/office.
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Athena Health Care Systems, one of the region’s most respected names in senior living, has an opportunity for an experienced Licensed Nursing Home Administrator to lead an exceptional team and center at Orchard View Manor in East Providence, Rhode Island.
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cms job Title: facility administrator in Providence, RI
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