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7) Monitor and facilitate activities related to Contracts, SOWs, Third Party Risk, Sourcing, AP, Ariba, Medicare & Medicaid Compliance, and audits. Ensure vendor compliance through oversight of, and engagement with; Ariba, Contracts, Third Party Risk, Medicare Compliance, AP, Sourcing, and internal/external Auditors.
$43,700 - $107,200 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Audit and Reimbursement II will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services.
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Maintains current knowledge of all present and future quality mandates from regulatory bodies including NCQA, Executive Office of Health and Human Services, Centers for Medicare and Medicaid Services and other regulatory bodies.
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Checking Medicaid eligibility. Other duties as needed to assist the Billing Supervisor and other managerial staff as requested. Checking Medicaid eligibility. Our goal is to help all members of our community become healthier, more self-reliant and better informed to meet their economic, social and emotional challenges.
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Five (5)+ years' experience with commercial, Medicaid or Medicare provider relations, communication, policies or related experience. Five (5)+ years' experience with a managed care organization or a health care related organization (HMO; Medicaid, Medicare.
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Three (3)+ years of progressive experience in Behavioral Health managed care operations and provider relations with BH and substance use disorder providers. Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma.
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This role also requires knowledge of health plan operations including Medicare and Medicaid plans, claims processing, EDI transaction processing, enrollment, financial reconciliation, and IT systems knowledge.
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The technical writer will be responsible for creating a Medicaid tool that provides case workers clarity of policy and system action to result in correct medical eligibility determination. The Technical Writer will review and identify existing Medicaid policy and update existing documentation to clarify and explain complex policy.
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The ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations. The ideal candidate will also be knowledgeable in Medicare, Medicaid, and private insurance, as well as the ability to complete relevant insurance documentations.
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Project management experience Skills: MEDICAID MEDICARE HEALTHCARE EducationVerifiable High School diploma or GED required; Bachelor’s degree preferred. In this role you will be a part of a collaborative cross-functional team charged with ensuring that the evolving administrative physician operations which support MinuteClinic and CVS Health comply with internal and external regulations, standards, and practices.
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Graduate of an accredited School of Nursing (RN, BSN or LPN)Looking for a MDS Coordinator with PDPM experienceCurrent/active licensure for Registered Nurse or Licensed Practical Nurse in RIMinimum 3 years clinical experience in a long-term care settingPrior MDS/RAI experience preferredDemonstrated clinical assessment skillsKnowledge of Medicare and Medicaid regulations and coverage guidelines as related to skilled nursingFull COVID vaccination is required.
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