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Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing facility therapies, and all outpatient procedures pursuant to applicable Medicare and Medicaid criteria, iCare guidelines, and PA Department policies and procedures.
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Quality Care: One of the only hospitals in Nashville with a Five-Star Rating from the Centers for Medicare & Medicaid Services, Top 5% in the U.S. for spinal surgery, numerous Healthgrades awards for spinal and joint replacement surgery.
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Experience in insurance and Medicare/Medicaid billing and reimbursement preferred. Experience in insurance and Medicare/Medicaid billing and reimbursement preferred. The Home Health Admissions Coordinator is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation.
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The AVP of Reimbursement will be responsible for the direction of all operations activities of the Reimbursement staff’s effort to comply with Medicare, Medicaid, TRICARE, and Corporate rules while adhering to policies and obtaining appropriate payment from government health insurance programs.
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General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred. 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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Support the compliance of the Philips Biomed/Clinical Engineering program which includes Centers for Medicare & Medicaid Services (CMS), FDA and accreditation agencies. Coordinate and work with sales, local service and back-office operations teams.
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The Audit and Reimbursement Senior , 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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Captures the RUG score which reflects the care and services provided Demonstrates an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid Ensures timely electronic submission of all Minimum Data Sets to the state data base.
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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), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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In compliance with the emergency regulation issued by the Centers for Medicare & Medicaid Services (CMS) dated November 4, 2021, and company policy, this role requires you to have received the first dose of a two-dose COVID-19 vaccination series (or a one-dose COVID-19 vaccination) by December 6, 2021, or to have applied for a medical or religious exemption.
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Answer questions about Medicare and Medicaid. Knowledgeable about Medicare and Medicaid. We're looking for a Remote Customer Service Representative , working in Healthcare Systems and Services industry in Nashville, Tennessee, United States.
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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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Proficient in processing/auditing claims for Medicare and Medicaid plans. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations.
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To conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members. to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members.
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E Medicare Part D, Commercial Plans and State Medicaid, etc) Educates patients regarding availability of alternative insurance options, such as providing Medicare part D assistance and education.
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medicare medicaid jobs in Brentwood, TN
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