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Medicare Ops Specialist Jobs

Medicare Specialist (Remote) Jobs
By Sedgwick At Oregon, United States
Thorough knowledge of claims management
Compiles, reviews and analyzes claim files and/or management reports.
Maintains thorough understanding of service and products offered by Medicare Compliance department.
Excellent oral and written communication, including persuasive writing skills
Strong analytical and interpretive skills
Requests rated-ages; tracks files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required.
Medicare Set Aside Specialist
By Sanderson Firm PLLC At Florida, United States
·Strong interpersonal, time management and organizational skills.
·Effective multi-tasking skills in a high-volume environment.
·Excellent written and verbal communication skills.
·Certification as a MSCC, CMSP, CLCP or CNLCP, preferred.
·Understand and apply evidence based medical treatment guidelines, and/or CMS guidelines to future care recommendations.
·Identify and outline Medicare and Non-Medicare covered treatment.
Billing Specialist (Medicare Hmo)
By Acadian Companies At Lafayette, LA, United States
Excellent interpersonal skills and time management
Other duties and responsibilities as assigned
Qualifications:** - High school diploma or equivalent
Previous medical billing experience preferred
Essential Functions:** - Responsible for claim status checks as needed to ensure proper resolution
Initiating contact with insurance providers as needed
Specialist, Medicare Member Engagement (2021610)
By Molina Healthcare At United States
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Participates in regular member benefits training with health plan, including the member advocate/engagement role.
2 years experience in customer service, consumer advocacy, and/or health care systems.
Experience conducting intake, interviews, and/or research of consumer or provider issues.
Basic understanding of managed healthcare systems and Medicare.
Log all contacts in a database.
Medicare- Sales Operations Integrity Specialist
By Florida Blue At , $61,000 - $76,200 a year
Income protection benefits: life insurance, Short- and long-term disability programs;
Additional voluntary benefits available; and
The essential functions listed represent the major duties of this role, additional duties may be assigned.
Develop and maintain a Medicare Sales Operations Integrity plan and KPIs that align to CMS marketing and sales related practices
Work closely with sales channel leaders and their teams to collect and share data that strengthens compliant outcomes
Collect, analyze and report on data from various Sales activities to identify potential risk
Greenway Maintenance & Ops Specialist
By Mecklenburg County At , $21.90 an hour
Combination of relevant education and relevant experience accepted?: N/A
Experience working with trail systems
Perform complex maintenance, repair, remodeling and renovation of various buildings, facilities, and equipment
Prepare daily inspection reports, pre-trip checks, logs and operating records for equipment or infrastructure
Train or supervise other subordinate staff in the operation or maintenance of various equipment
Order materials and ensure that correct construction methods are utilized
Ad Ops Specialist Jobs
By Clutch Group, Inc. At , , Nj $80,000 a year
Set up, optimize, and manage PPC campaigns in Google Ads and Facebook (search, display, shopping, video).
Maintain regular communication with clients to discuss results and offer performance improvement suggestions.
2+ years of experience in Google Ads and Google Analytics.
2+ years of experience in META (Facebook/Instagram), TikTok, or other social platforms.
Strong analytical, problem-solving, and organizational skills.
Experience with Bing Ads, Google Data Studio, WordPress, or HTML is a plus.
Medicare Enrollment Specialist Jobs
By VNS Health At , Manhattan, Ny $68,200 - $85,200 a year
Experience marketing to a culturally diverse target population required
Excellent verbal and written communication skills, including the ability to speak in front of large groups required
Coordinates home nursing assessment visits, when appropriate, to ensure successful enrollment into the program.
Educates VNS Health Plans MA and/or MLTC members on MAP and conducts telephonic enrollments into the product.
Performs retention efforts developed by VNS Health leadership to reduce member turnover.
Educates consumers who contact VNS Health Plans via website about VNS Health Plans Medicare products.
Business & Operations (Bis/Ops) Specialist - Remote
By CEDARS-SINAI At , Los Angeles, Ca $112,700 - $185,900 a year
Bachelor's degree in Business Administration, Business Management, Healthcare Administration, IT, or a related field.
Leverage knowledge of Cedars-Sinai people, processes, and culture to advise minimal viable product (MVP) definition and go-to-market strategies.
Three (3)+ years of experience in healthcare technology business operations including strategic development and business planning.
Monitor project schedule, define appropriate resources, make adjustments that are within scope of responsibility and recommends changes as appropriate.
Generate metrics report to leadership on a periodic basis.
Communicate internally to bring findings from various digital initiatives to service line operations and strategy teams.
Medicare Enrollment Specialist - Remote
By ASK Consulting At ,
Ability to pass licensing exam and Carrier certifications annually and maintain good standing
Actively manage all assigned appointments to ensure all retirees needs are met on a timely basis
Deliver a consistently positive customer experience in a highly ethical and professional manner
Expiry Date: 04 September 2023
Meet and/or exceed monthly sales goals and service levels
Handle inbound service calls by providing accurate and complete information via researching/selling/locating licensed agent
Senior Benefits Ops Specialist
By Coinbase At Boston, MA, United States
Manage global benefits administration, including vendor management, enrollment processes, record maintenance and leave of absence cases
Design and manage benefit processes and support model, creating a seamless employee experience
Oversee data integration and file management workflows between Coinbase and benefit providers
Create and manage tools that the benefits / payroll / Operations teams can all use to drive efficiencies
5+ years of International Benefits administration experience in a fast-paced environment
Participate in new benefit program projects, ensuring operational components of plan are executed on-time and accurately
Infra Ops Specialist Jobs
By KTek Resourcing At Peoria, IL, United States
AWS Practitioner, Knowledge in Cloud Services & Monitoring
• Manage the day-to-day operations activities.
• Responsible for transition knowledge from Application/Support team to monitoring team.
• Responsible for managing the L1 Application Monitoring team at offshore
• Conduct daily huddle with the team to track the issues reported daily shifts.
• Track and maintain all the Activities in scope for the team and the related SOPs.
Implementation Specialist, Experience Ops
By Imagine Learning At United States
Accurately assess current district requirements for rostering and integration understanding their capabilities and offer solutions for basic integration requests.
Location: In this US-based position your location will be remote, preferably in Phoenix, AZ.
Writing skills to create detailed and accurate documentation of all customer interactions in the appropriate business tool (NetSuite, Jira, ZenDesk, etc.).
Basic experience with Salesforce or other CRM, with ability to search, add data, and retrieve reports.
Experience working with School District Staff and Administrators in a K-12 environment.
Outstanding problem-solving capability and critical thinking skills.
Medicare/Acd Specialist (Rn) - Remote
By Acentra Health At Nashville, TN, United States
Do you value care management and quality improvement?
Knowledge of CMS medical necessity guidelines and benefit coverage criteria strongly preferred.
Are you an experienced Clinical Reviewer looking for a new challenge?
Maintain current knowledge of CMS regulations, guidance documents, and transmittals
Review monthly CPT code report and make suggestions based on the data; review with the Manager prior to meetings
Perform ongoing assessment and maintenance of codes within the ACD and update as appropriate, in collaboration with manager and client
Medicare Risk Adjustment Coding Specialist
By American Health Plans Inc. At Nashville Metropolitan Area, United States
• Escalate appropriate coding audit issues to management as required
• Strong organizational skills; ability to time manage effectively
o 2 years’ experience in managed healthcare environment related to claims and/or coding audits
o Significant HCC experience (including knowledge of HCC mapping and hierarchy)
• Knowledgeable of coding/auditing claims for Medicare and Medicaid plans
• Extensive knowledge of ICD-9 & ICD-10 diagnostic coding and auditing
Appeals Specialist (Medicare Part B) - Palmetto Gba
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
Experience working with Medicare Part B
Prior medical office or insurance experience strongly preferred.
Our Comprehensive Benefits Package Includes
Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
Updates letters and documents within the department when necessary.
Pricing Ops Specialist Jobs
By Nevro At Redwood City, CA, United States
BS/BA required in Business, Economics, Finance, Statistics or Marketing. (MBA preferred)
Excellent organizational and mathematical skills
Demonstrated communication, presentation, and interpersonal skills.
Documents current-state and implementation of improvements for processes relating to pricing requests, approvals, programs and reporting.
Participates in new system end user testing and validation activities.
Supports the US pricing committee with gathering and documenting deal information and decisions.
Associate Claims Specialist: Medicare (Remote)
By Providence Health Plan At , Beaverton, 97005, Or
Provide and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products
2 years' experience with claims, customer service or accounting
We welcome 100% remote work for residents living within a thirty mile radius of Portland, OR.
Required qualifications for this position include:
Preferred qualifications for this position include:
Check out our benefits page for more information about our Benefits and Rewards.
Lead Payroll Ops Specialist
By Activision At , Santa Monica, Ca $31.08 - $57.46 an hour
Provides support with duties as assigned by department management and Payroll Tax Operations
Daily review and handling of Payroll department cases via Company’s case management system
Supports Payroll shared service management team with preparation of documents, timelines and results
Knowledge of state and federal wage and tax laws and overtime requirements.
Ability to effectively communicate information to employees and management.
Partners with Finance, Human Resources, Recruiting, Operations and other departments to ensure exceptional Payroll Operations accuracy and timeliness
Billing/Collection Specialist - Medicare
By Northside Hospital At Atlanta, GA, United States

2023-37541 Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more ...