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Clinician will be either credentialed with United Healthcare, Cigna, BCBS, Alliance Medicaid, Partners Medicaid, Amerihealth, WellCare, Carolina Complete Health, and/or Healthy Blue or willing to pursue in order to provide care to our client population.
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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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We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. HCA Healthcare Co-Founder. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing.
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Knowledge of reimbursement pathways (specialty pharmacy, buy-and-bill, retail) Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geographic region. ADARs will also be required to coordinate and communicate cross-functionally within NPC (e.g., Patient Support Center, Customer Engagement, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates.
$174,400 - $261,600 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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If employed at one of our senior living communities that receives Medicare or Medicaid funding, team members must not be considered an “Excluded Party” as defined by the U.S. Department of Health and Human Services, any state Medicaid Programs, and any additional federal and state government contract programs.
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Demonstrated understanding in; HIPAA, Privacy Act, FWA, Stark and Anti-kickback laws, and Medicare/Medicaid regulations. Provide direct oversight of the compliance plan and program, including but not limited to the following: billing and coding, privacy, conflicts of interest, anti-kickback and physician self-referral, HIPAA Privacy, Stark law, and fraud, waste, and abuse (FWA.
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PPO: 26%, Medicare: 23%, Blue Cross: 21%, Medicaid: 9%, Self Pay: 9%, Commercial: 5%, Workers Comp: 4%, HMO: 3%, Maternal-Fetal Medicine (Perinatology) Jobs. PPO: 26%, Medicare: 23%, Blue Cross: 21%, Medicaid: 9%, Self Pay: 9%, Commercial: 5%, Workers Comp: 4%, HMO: 3.
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Educate payers (Health plans, Medicare, Medicaid), key decision makers (P&T members, opinion leaders, pharmacists), agents (specialty pharmacy, GPO, and PBMs); differentiate products based on clinical (efficacy & side effect profiles) and economic data to support formulary decisions.
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Inform the Patient Access Director of any significant issues in the patient access area (i.e. preregistration delays, pre-authorization back logs, increased time to register patients, etc.) Referral services for child, elder and pet care, home and auto repair, event planning and more.
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The SNP Coordinator is responsible for developing, documenting and implementing a program designed to address the medical, physical, mental, emotional, spiritual, social and supportive needs of the member who is dually eligible for Medicare/Medicaid health coverage.
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Serving millions of Medicare and Medicaid patients, Optum is the nation’s largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family of businesses. As an CCM Nurse Practitioner/ Physician Assistant per diem you will provide care to Optum members and be responsible for the delivery of medical care services in a periodic or intermittent basis.
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Provide guidance related to cost allocation for public assistance programs including but not limited to Medicaid,the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF.
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Competitive compensation ( $105 per completed Medicare visit, $90 per completed visit for Medicaid and Affordable Care Act Patients)HCC or risk adjustment coding experience is preferred, but not necessary.
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General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred. Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required.
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Facilitates monthly credentialing for medical and allied health professional staff to ensure compliance with the Medical Staff Bylaws, Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), URAC, as well as State regulatory requirements and all other accreditation requirements.
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tricare medicaid jobs in Woods Cross, UT
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