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The programs the AVP will have oversight for include but are not limited to: MACRA/MIPS, 21st Century CURES, Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage; and commercial payer value programs.
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Foundational understanding with aptitude to become a subject matter expert in Medicare Advantage, ACO REACH, MSSP and other value-based care programs. Medicare Advantage Part C and D bid development expertise.
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Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care. Provides utilization management services, in coordination with other Case Management staff, providers, and other healthcare team members, using pre-established guidelines and criteria to perform review activities to assure the proper utilization of hospital services and payment of those services by Medicare, Medicaid, and other third-party payors.
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These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Previous Medicare experience a plus.
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An Enrollment Specialist is a member of the Patient Engagement Specialist (PES) team, telephonically educating and enrolling patients in a Medicare-sponsored care coordination program designed to help the patient better manage their chronic illnesses (diabetes, high blood pressure, COPD, etc.
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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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Knowledge of analytics tools like Tableau, Power BI, Excel VBA Macros, RSPSS, SAS is an added advantage. You're the right fit if: You’ve acquired 3+ years of experience working as Data Analysist in Supply ChainYour skills include experience with QlikView, Adobe Analytics, Google 360, Python, R Programming, Scala, Apache Spark, and AWS Redshift.
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Working knowledge of Medicare compliance, OSHA, and HIPAA. Comprehensive understanding of fee schedules, payor policies and managed care contracts, including Medicare and Medicaid. Strong working knowledge of ICD-10, CPT, HCPCS, referrals and pre-certification procedures, as well as documentation guidelines.
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Working knowledge or understanding of: principles of Palliative Medicine, including when a patient may be appropriate for home health or hospice care; Medicare/Medicaid regulations; and interdisciplinary process.
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Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly preferred) We are Medicare certified. HCA Healthcare Co-Founder. Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly preferred.
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Experience in reputed UPS manufacturer like Liebert, Powerware, MGE, APC, Chloride, Mitsubishi, Toshiba will be an added advantage. Experience in reputed UPS manufacturer like Liebert, Powerware, MGE, APC, Chloride, Mitsubishi, Toshiba will be an added advantage.
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The Application Development Senior Manager will oversee a team dedicated to the end-to-end implementation of solutions for the core administration of Medicare Advantage and CareAllies health plans.
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Initiates phone contact with eligible Medicare patients in attempt to enroll them in CCM/RPM/RTM programs on behalf of physician practice. Our main services are to help medical offices with programs like Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Tele-Health.
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Working Advantage: Cost-free employee savings program for electronics, appliances, apparel, cars, flowers, fitness memberships, gift cards, groceries, hotels, movie tickets, rental cars, special events, theme parks, and more.
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Through T-Mobile’s products and services, Verge Mobile’s retail stores have the advantage of being one of the few places that truly help consumers stay connected with those that matter most to them.
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medicare advantage jobs Company: Kover in Brentwood, TN
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