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Three (3) or more years of professional experience in Case Management, in Medicaid and/or Medicare, specifically in the delivery of care for elderly or special needs populations such as the Aged, Blind and Disabled (ABD) and those enrolled in Long-Term Services and Supports (LTSS) Waiver Services, in hospice and/or in nursing facilities.
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As a Medicare Sales Agent (internally titled Advocate Agent) you'll enjoy unlimited earning potential, the convenience to work from home, access to best-in-class paid training, and potentially the opportunity to move into a leadership role.
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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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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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As an Advocate Agent you'll serve as a trusted expert on all things Medicare insurance-related and have access to the nation's best carriers (Humana, Anthem, UnitedHealthcare & more!) You will primarily handle inbound calls from consumers interested in saving on their Medicare expenses and optimizing their benefit coverage while also helping build your client portfolio through outbound consumer engagement efforts.
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Perform audit activities with respect to the following systems: Resident Trust Funds, Medicare regulatory requirements (ABN letters, cut letters, triple checks), Segregation of duties, Continued function of management processes (including pending meetings, collection blitz reviews.
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CommuniCare Advantage, a member of CommuniCare Health Services, is currently recruiting a Chief Compliance Officer for our Medicare Advantage plan. Chief Compliance Officer, Medicare Advantage.
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Extensive experience in healthcare contracting, with a critical understanding of PBMs, National Health Plans, Medicare Part D/B, GPOs, VA/DoD, Medicaid, and the evolving market landscape. Minimum of 12 years of pharmaceutical industry experience, with significant expertise in at least two of the following areas: Channel Strategy, Finance, Pharmacy, Pricing, Trade, or Market Access.
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Job DescriptionJob DescriptionHueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in West Virginia. Whether it be for supplemental income or the desire for community connection, this position invites you to become an integral part of thethriving HRA landscape, fostering connections that go beyond the clinic.
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To conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members. to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members.
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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. Become a part of our caring community and help us put health first.
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We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
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A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH.
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Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements.
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Experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management. The Medicare Advantage Quality Consultant is expected to assess the needs of each individual PCP practice, and use a combination of on-site individual office based, entity level based, video conference, teleconference, and electronic mail interactions to drive engagement and exemplary value creation, impact and cost control, and ROI/fiscal outcomes as set by the Organization for government programs.
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medicare job in Charleston, WV
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