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Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
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Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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The Registered Nurse candidate must be a licensed Registered Nurse eligible to practice in SD. Training for the survey process is through required online Centers for Medicare and Medicaid Services (CMS) courses and through precepted surveys in licensed healthcare facilities.
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Net Framework, PeopleSoft, Mulesoft, Sitecore/CMS, and Azure. Net Framework, PeopleSoft, Mulesoft, Sitecore/CMS, and Azure. NET, Azure, Peoplesoft, Mulesoft and Sitecore platforms, but additional applications may be added in the future, as needed.
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The Documentation Specialist will play a key role in documenting template/component designs, CMS author dialogs, and changes, while effectively communicating with stakeholders and cross-functional teams.
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Be the subject matter expert for US healthcare government and regulatory published drug information and policy data sources (CMS, FDA, etc.) Be the subject matter expert for US drug pricing benchmark data types including WAC, AWP, NADAC, ACA FUL, ensuring our solutions meet customer needs in existing and future commercial data workflows.
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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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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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Diagnoses, troubleshoots, and repairs facility mechanical/electrical systems; facility HVAC equipment and systems; pneumatic and/or hydraulic systems; conveyors; overhead cranes; machining centers; and robotic welders.
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