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Partner with ERISA counsel and the Benefits Compliance Coordinator to understand changes in regulations in order to effectively communicate changes to retirement call centers and ensure all procedures in place comply with all regulations (Summary of Material Modification, Medicare Part D notices, privacy notices, etc.
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The Health Quality and Stars team centralizes quality improvement and governance processes targeting Humana's Medicare Advantage members, and also manages compliant data submissions to CMS in adherence with the Stars Rating Program.
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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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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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The Compliance Manager will assist in developing and monitoring compliance with all CMS, Medicare advantage, Part D and DSNP regulatory requirements; will serve as a subject-matter expert on compliance topics, and by maintaining comprehensive knowledge of applicable laws, regulations and policies; will track and regularly report on Compliance Program metrics.
$60,000 - $85,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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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The ideal candidate will also understand the build, measure, learn and test and learn framework, how to manage a program learning agendas, and have financial and/or operational experience across Primary Care, Medicare Advantage, Pharmacy, or Home.
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General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred. Exact job experience is considered any of the above tasks in a Medicare certified.
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Maintains compliance with Medicare Conditions of Participation, Joint Commission standards, Hospice and Professional Standards of Nursing Practice, and agency specific policies and procedures. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
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Compliance: Ensuring that clinical departments are following all relevant financial and regulatory guidelines, including HIPAA, Medicare, and Medicaid regulations. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
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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. Proficient in processing/auditing claims for Medicare and Medicaid plans.
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Experience: Knowledge of Medicare, Medicaid, and 3rd party vendors is a plus. Education: High school diploma or GED. About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
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Joining CDS, an Advantage Solutions Company, means joining a network of 65,000 teammates serving 4,000+ brands and retail customers across 40+ countries. Open interviews are every Thursday from 1pm - 4pm at the warehouse location, let the Costco greeter know you are here to see the CDS team.
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Primarily focused on cross-selling to existing customer base and engaging in outside sales activities (i.e. Membership Advantage onsite presentations, business sales calls, community financial literacy events, etc.
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Knowledge of Workers’ Compensation, Medicare and/or clinical standards of practice preferred. It operates more than 800 onsite and nearsite wellness centers in 45 states and Guam, delivering care through the Digital Wellness Center and onsite, nearsite, mobile, and event solutions.
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medicare advantage jobs Company: Kover in Franklin, TN
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