Process, track and monitor client requests across all aspects of Employer's offered services for a) EHR credentialing reviews (if applicable), b) corrective action solutions, c) HEDIS chart abstractions, d) Medicare risk adjustment reviews and e) custom chart abstractions; Work with team to assist and respond to Q & As for the new EHR tasks and implementations; Provide su

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Develop an understanding of the overall concept of the company, including the brand, customer, product goals and all other aspects of service; Develop a working knowledge of the assigned department; Attends unit, departmental, and corporate meetings as assigned; Work collaboratively and develop skills needed to carry out day to day work and/or participate in departmental

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Work with the agile team to participate in agile ceremonies like grooming, planning, standup, retrospective, demos Actively contribute to grooming, and standup, create & update tasks estimate and status Design and develop modern data ingestion pipeline utilizing tools like ADF (Azure Data Factory), Databricks, MS SQL Extensively work on Azure Cloud Platform Write complex

Nurse Practitioner (Per Diem) Job Locations US GA Douglas Job ID 2020 3408 Type Per Diem Overview ComplexCare Solutions (CCS) specializes in helping those in need by delivering high value in home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health ri

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Direct responsibility of the day to day and the overall performance, training, and development of the Communication Center Representative team assigned to telephonic member outreach for information collection, coaching and education; Develop, motivate, and assist a team of 10 15 non clinical Call Center Representatives (CCR's) in the problem solving resolution process in

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin

Knowledge of CMS Regulations and NCQA HEDIS Guidelines; Knowledge of Evidence based Clinical Practice Standards American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD 9, ICD 10 and CPT 4 coding practices; Complete comprehensive, accurate and thorough review of the assigned member population, includin