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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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Sound Physicians is forming its own Medicare Accountable Care Organization called Sound Physicians Long Term Care Management, LLC (LTCM) which will be a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) for Medicare Beneficiaries who reside in long-term care (LTC) facilities.
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Analytics experience with Medicare Advantage, Medicare FFS, MSSP and ACO programs, and commercial populations. Proficiency with data visualization tools such as PowerBI, Tableau, or Sigma Familiarity with Snowflake or other cloud-based query applications Actuarial/statistical based analysis Experience with extraction, transformation, and loading disparate healthcare data sources Demonstrated ability to work on multiple projects simultaneously while leading a team Understand current issues in health care financing, delivery, policy, and regulations.
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An active, independent California Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Clinical Psychologist Residence in Tennessee Though we do not require our providers to see Medicare patients, you must not have opted out from Medicare Have access to reliable and stable internet while working remotely; experience with Google Suite is a plus.
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Be a subject matter expert in Medicare Advantage and Federal ACOs, e.g., ACO Reach. Medicare Advantage Part C and D bid development expertise. Extensive knowledge of Medicare healthcare industry and trends; medical, pharmacy/Part D, SDoH, behavioral health experience especially valuable.
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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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Our primary care physicians are true hands-on caregivers transforming the health and lives of seniors on Medicare Advantage. Holistic Health Services: Acupuncture, Tai Chi, Yoga and Nutrition. Through our Value Based Care approach, you and your patients thrive in our high-touch, relationship-centered model – something the traditional, FFS healthcare model cannot provide.
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Keeps contracting information for all contracted nursing centers and hospitals up to date in accordance with Caris policy and Medicare and State regulations. At Caris HealthCare the Hospice Sales Representative develops and maintains working relationships with referral sources and professional community contacts to increase access to hospice care by terminally ill patients.
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Serve as subject matter expert on federal health care laws and regulation, regulatory and enforcement environment affecting the business, including federal and state anti-kickback and self-referral laws, fraud and abuse, False Claims Act liability, government payor billing and reimbursement requirements and payment, government audits and audit readiness, Medicare sales and marketing rules and regulations and compliance programs.
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You have a general understanding of healthcare areas, such as claims processing, EHRs, medical billing and coding, value-based care models, and Medicare/Medicare Advantage. You have a general understanding of healthcare areas, such as claims processing, EHRs, medical billing and coding, value-based care models, and Medicare/Medicare Advantage.
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Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to forecast patient risk scores and return on investment based on historical data and project variables. Experience in using business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data (SSRS, Power BI, Tableau.
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Prior experience in reimbursement methodologies (including Medicare/Medicaid and other government payors), revenue cycle, statistical modeling, financial reporting, contract management systems or data analytics.
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Under the direction of the President/CEO and the Business Operations Officer, the Medicare Insurance Compliance Manager's purpose is to provide oversight with all CMS and state regulatory requirements, contract requirements, company policy and procedures, and for developing, conducting, coordinating and reporting audit and investigative activities for the purpose of preventing and detecting fraud, abuse, and waste.
$60,000 - $85,000 a yearFull-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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The ideal candidate is an accomplished subject matter expert who is passionate in making a real impact on preserving the Medicare Trust Fund. He/she should be a confident public speaker with excellent written and oral presentation skills.
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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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medicare job in Nashville, TN
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