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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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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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Support chart audit processes, including audit provider and vendor documentation of ICD-9 and ICD-10 codes to ensure adherence with Center for Medicare & Medicaid Services (CMS) risk adjustment guidelines.
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One (1) year experience with Maryland Department of Human Services state Medicaid waiver and in-home aide programs. Are you experienced with Maryland Medicaid Waiver programs, credentialing/maintenance and the overall understanding of Maryland RSAs designation.
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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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JOB SUMMARY: The Medicaid Billing Specialist processes the Medicaid insurance claims by entering authorizations into the billing software and researching denied claims for the Fortitude DC/Spring Flats Services within the Homeless and Housing Services Department.
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The new Magnet designation is in addition to several other prestigious recognitions which include: a five star rating from the Centers for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation's highest performing hospitals, and among the top 10 Major Teaching Hospitals, an A for Patient Safety by The Leapfrog Group, the #1 hospital in the DC metro area by U.S. News & World Reports, and being nationally ranked in gynecologic care.
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Inova Fairfax Hospital is proud to announce that the American Nurses Credentialing Center (ANCC) awarded Magnet® designation, the most prestigious accolade for nursing excellence, to our hospital in December 2020.
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Demonstrable familiarity with Medicaid, national and state policies that affect Medicaid programs and administration, dual-eligible populations, strategies to leverage Medicaid programs to address upstream non-medical, health-related needs of older adults, women, and low-income populations on older adults is strongly preferred.
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Under the direction of the Director, Federal Government Relations, the Government Relations Manager represents the American Heart Association before Congress, the Executive Branch, and coalition partners on a portfolio of legislative issues including preserving and expanding healthcare access through the Medicare, Medicaid, and Affordable Care Act programs; women and childrens health; cardiac rehabilitation; and peripheral artery disease.
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10/+ years of experience (Principal Researcher) or 15/+ years of experience (Senior Fellow) in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level.
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The position will be responsible for leading the qualitative and quantitative research and data analytics related to policy, development, and implementation of an efficient, coherent, and cohesive system of oversight for Medicaid-financed LTSS. This position plays a key role in supporting LTCA’s overall LTSS Quality Improvement Strategy and alliance with District and Federal requirements.
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The Policy Analyst’s primary responsibilities will be to support Governors on matters related to a variety of health policy issues that may include: social determinants of health, public health infrastructure, public health workforce, public health data modernization, rural health, chronic disease, infectious disease, immunizations, maternal and child health, Medicaid and other aspects of public health.
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If you have six (6) plus years of experience working with healthcare and/or life sciences clients on compliance issues with fraud and abuse laws and regulations, together with working knowledge of FDA regulatory requirements and Medicare and Medicaid payment rules, and experience related to internal investigations and responses to the HHS Office of Inspector General (OIG) and U.S. Department of Justice (DOJ), we would be interested to discuss this career advancing opportunity with you.
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Ensures all programs and services within the Behavioral Health Service Line meets all criteria related to the Centers for Medicare and Medicaid (CMS), the Joint Commission on Accreditation of Healthcare Organizations (TJC), the Virginia Department of Healthcare Licensing (DOL), the American Society of Addiction Medicine (ASAM) and the Virginia Department of Behavioral Health and Disability Services (DBHDS) rules and regulations.
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medicaid job in Alexandria, VA
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