- Corewell Health (Grand Rapids, MI)
- Job Summary The Medicare Quality Specialist , Pharmacy will assist the Medicare Adherence Pharmacists Team to improve Medicare Star Ratings and CAHPS by ... collaboration with internal and external partners, assisting with the administration of Medicare programs, and other projects assigned to support the Medicare … more
- Medical Mutual of Ohio (OH)
- …help our members achieve their best possible health and quality of life. ** Medicare Sales Operations Specialist ** Executes all end-to-end functions relating to ... and other fulfillment needs identified for the business area. **Sr. Medicare Sales Operations Specialist ** Executes end-to-end functions relating to… more
- Medical Mutual of Ohio (OH)
- …substance abuse and nicotine testing._ **Title:** _Clinical Services Support Specialist ( Medicare UM)_ **Location:** _Ohio_ **Requisition ID:** _2400556_ ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under general… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification, required + A Certified Risk Adjustment...of ICD-10, CPT and CPT (II), and HCPCS coding systems required + Knowledge of Medicare Advantage… more
- University of Washington (Seattle, WA)
- …has an outstanding opportunity for a **full-time, day shift, INSURANCE FOLLOW-UP SPECIALIST (Patient Account Representative 2).** **WORK SCHEDULE** + 40 hours per ... Shift + This position is Remote **POSITION HIGHLIGHTS** The Insurance Follow-up Specialist is responsible for the optimal payment of claims from commercial insurers,… more
- PruittHealth (Norcross, GA)
- …In-depth knowledge of various billing documentation requirements, the patient accounting system , and various data entry codes to ensure proper service documentation ... functions in non-acute settings * Knowledge of Patient Management information system applications, preferably MatrixCare, as well as spreadsheet, word processing,… more
- Healthfirst (NY)
- …new benefits, services, or other product changes, update processes and/or edit systems to accommodate regulatory requirements + Assist with ad hoc projects such ... as focus group studies, process improvement initiatives and program implementations, when applicable + Coordinate activities of product or project-specific cross-functional work teams / serve as liaison between product management and all levels of staff to… more
- Martin's Point Health Care (Portland, ME)
- …and education + 3+ years experience in managed care plan required; knowledge of Medicare Advantage (for Medicare Specialist ) or TRICARE (for USFHP ... are on a mission to transform our health care system while creating a healthier community. Martin's Point employees...appeals management process. Job Description Key Outcomes: + For Medicare Focused Specialist : + Researches, processes and… more
- Sea Mar Community Health Centers (Mount Vernon, WA)
- …by contracted entities such as Accountable Communities of Health and Medicaid/ Medicare organizations. + The TOC Integration Specialist must maintain the ... a mandatory COVID-19 and flu vaccine organization Transition of Care Integration Specialist - Posting #27118 Hourly Rate: $26.52 Position Summary: Sea Mar Community… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …irregularities; determining continuing needs for Tele-Sale Agents, Benefit Navigators and Medicare Support Specialist . + Ensure all Tele-sale Agents, Benefit ... Navigators, and Medicare Support Specialists are conducting activities that are in...the Training Director + Maintain hard copy/ electronic filing system + Maintain office supply inventories + Record, compile,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, customer ... related to member and provider appeal issues, including identifying needed system changes and contacting other areas to implement those changes. **Responsibilities**… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …Accounting Billing System + Knowledge of working F .I.S.S.(Florida Institutional Shared System ) in order to resolve Medicare claim issues + Keep abreast of ... The Medicare Billing and Follow-up Representative are responsible for...inform ation contained within the Patient Accounting and Billing system to make decisions on how to proceed with… more
- Point32Health (Canton, MA)
- …(PBPs) are reviewed and ready for bid filing in CMS' Health Plan Management System (HPMS). The Senior Manager will also be responsible for either directly populating ... of the broader Product team who assist with product / system configuration, regulatory applications/filings, and day-to-day benefit adjudication matters. Overall,… more
- UCLA Health (Los Angeles, CA)
- Description Take on a key role within an award-winning health system . Help improve patient experiences and operational efficiency as part of a world-class healthcare ... can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is… more
- Henry Ford Health System (Troy, MI)
- …audit, compliance, and vendor-driven projects. Become proficient using the Altegra RiskView systems for both Medicare Advantage Risk Adjustment and Healthcare ... GENERAL SUMMARY: The Lead Coding and Education Specialist will support the activities that assure compliant...and accurate reporting of the health status of HAP's Medicare Advantage (MA) and Commercial Qualified Health Plan (QHP)… more
- Ventura County (Ventura, CA)
- …of payment systems , including CPT, ICD-10, and HCPCS codes for Medicare and Medi-Cal payment processing. They are adept with the Medi-Cal Provider Manual ... for Medi-Cal and/or Medicare and prepares reports; + Serves as lead biller/ specialist to the department; and + Performs other related duties as required. Medical… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: RMRA (Revenue Management Risk Adjustment) Health Risk Coding and Education Specialist - Level II, specific to the Risk Adjustment Coding and Clinical ... Condition Category (HCC). + Assist with all aspects of The Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) mandatory audits… more
- Medical Mutual of Ohio (OH)
- …(HCCs), for all risk adjusted product.** **.** **Knowledge of Electronic Medical Record systems and system logic** **.** **Basic to Intermediate proficiency with ... risk adjusted product.** **.** **In depth knowledge of Electronic Medical Record systems and system logic.** **.** **Intermediate proficiency with Microsoft… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the System Accreditation Specialist is responsible for providing system -wide consultative services to Houston Methodist entities that ... mentor, and educator for regulatory and accreditation programs; works across the system to assess, measure, and report compliance with standards; and develops,… more
- MetroLink (Los Angeles, CA)
- …grantors. + Ensure the efficient utilization of accounts receivable and project accounting systems , taking advantage of system capabilities. + Track and monitor ... Finance Specialist I, Grants Finance (Limited Term) Print (https://www.governmentjobs.com/careers/scrra/jobs/newprint/4709470)...program to increase the capacity of the regional rail system by adding double track, station platforms, grade crossing… more