- ChenMed (Cincinnati, OH)
- …is required. Working with seniors a plus, as is a general understanding of Medicare Advantage + A minimum of 2 years of business-to-business experience or ... talks, etc.) to help reach our ideal patients (ie, medically underserved, Medicare -eligible seniors, age 55 and older). + Cultivates strong relationships with health… more
- St Croix Hospice (Mendota Heights, MN)
- …compliance audit program tailored to meet the requirements of CMS, Medicaid, Medicare , Medicare Advantage plans, other government payors, private ... insurers, the Office of Inspector General (OIG) and the Department of Justice (DOJ). + Develop audit frameworks, methodologies and policies that align with regulatory requirements and best practices within healthcare. + Ensure audits are thoroughly documented… more
- CenterWell (Corpus Christi, TX)
- …of two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... care environment in a value-based relationship environment + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality indicators **Additional… more
- Ochsner Health (Luling, LA)
- …Knowledge of heath care systems and public programs such as those funded by Medicare , Medicaid, Medicare Advantage , and commercial insurance plans. + Strong ... interpersonal skills necessary to deal effectively and courteously with patients, families, multidisciplinary team members, departmental peers, and community agency personnel. **Job Duties** + Conducts patient assessment interviews, provides referrals and… more
- Ochsner Health (New Orleans, LA)
- …Knowledge of heath care systems and public programs such as those funded by Medicare , Medicaid, Medicare Advantage , and commercial insurance plans. + Strong ... interpersonal skills necessary to deal effectively and courteously with patients, families, multidisciplinary team members, departmental peers, and community agency personnel. **Job Duties** + Conducts patient assessment interviews, provides referrals and… more
- US Tech Solutions (Columbia, SC)
- …+ A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. + Team: Fast paced, Interactive team works ... with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral… more
- Bluestone Physician Services (Stillwater, MN)
- …Knowledge/Skills/Abilities + Demonstrated experience working across: + Health plans (especially Medicare Advantage ) + Providers and provider organizations + ... (ACO) was the best performing ACO in the country (https://bluestonemd.com/2023/09/bluestone-aco-delivers-excellent-care-to-medically-complex-elderly-patients-saves- medicare -26-6-million/) as measured by the overall savings per … more
- University of Miami (Miami, FL)
- …as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population preferred + Completion of Medicare ... annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition Category (HCC) - review and recertification preferred + Physical presence required at all GIM sites +… more
- Highmark Health (Cheyenne, WY)
- …Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including ... (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment… more
- Ochsner Health (Lafayette, LA)
- …Familiarity with health care systems and public programs such as those funded by Medicare , Medicaid, Medicare Advantage and commercial insurance plans. **Job ... Duties** + Conducts complex assessment, independent selection and use of varied in-depth therapies in the treatment of individuals with multi-problem dual diagnosis substance abuse problems (as defined by Licensed Professional Counselors Board of Examiners in… more