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Required Certifications/Licensure : Certified Professional Coder (CPC), CCS, RHIA, RHIT, CPMA, or CCS-P Required Training : Background in coding guidelines and regulatory laws for federal and state payors.
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Maintains tracking on RTP, FSS, denial from private insurance and other claims queries or Medicare correspondence as required if applicable. The Billing Specialist will follow uniform billing procedures and practices according to Medicare, Medicaid, 3rd party payers, and private pay in accordance with the HIM-11 guidelines.
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The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to local Medicare patient populations at our innovative network of neighborhood primary care centers.
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Job SummaryThis expert level senior inpatient coder is responsible for leading coding teams, coder training, work que management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation.
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Experience working in a value-based care, senior care, and/or Medicare managed care. Support pharmacy performance improvement activities and align pharmacy services with improvement quality metrics and Medicare part D performance.
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The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. Recent example projects include development of a 3-year growth strategy for the business unit, developing a refreshed membership acquisition strategy, identifying key go-to-market priorities, assessing the performance of strategic initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, and identifying improvement opportunities for a key business function.
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As part of the Signify Health's Member Engagement team, you will contact members of various Medicare Advantage and Medicaid health plans by phone to offer, explain, and schedule a free in-home or virtual healthcare evaluation.
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Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives.
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Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and "How-To" documents.
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As a Medicare Sales Agent (internally titled Advocate Agent) you'll enjoy unlimited earning potential, the convenience to work from home, access to best-in-class paid training, and potentially the opportunity to move into a leadership role.
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High School Diploma (equivalent) Preferred experience with: · Strong knowledge of Medicaid, Medicare, & Disability policies and procedures · Strong knowledge of major hospital systems Physical Demands/Working Conditions: Requires prolonged sitting, standing, or walking some bending, stooping and stretching.
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You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.
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Medicare knowledge required with minimum of one year of Medicare sales and one Annual Enrollment Period preferred. As an Advocate Agent I, you'll serve as a trusted expert on all things Medicare insurance-related and have access to the nation's best carriers (Humana, Anthem, UnitedHealthcare & more.
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Reviews and adjudicates complex or specialty Medicare claims and/or non-medical appeals. Provides prompt, accurate, thorough and courteous responses to all complex inquiries from Medicare Advantage members and providers.
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In this role you will support a Manager of Sales Administration, Senior Manager of Medicare Sales, a Director, Sales and Marketing Support Executive, up to career Medicare Sales Representatives, as well as all our external agents state wide.
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