Demonstrates sound knowledge of reimbursement and billing practices for Medicare, Medicaid, managed care, charity care and other third-party payers * Demonstrates cultural sensitivity * Maintains ...
Demonstrates sound knowledge of reimbursement and billing practices for Medicare, Medicaid, managed care, charity care and other third-party payers * Demonstrates cultural sensitivity * Maintains ...
Casualty Manager
Guaynabo, PR · On-site
Casualty Manager Company: Triple-S Propiedad Job Location (Short): Guaynabo, PR Posting Start Date ... We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid ...
Casualty Manager
Guaynabo, PR · On-site
Casualty Manager Company: Triple-S Propiedad Job Location (Short): Guaynabo, PR Posting Start Date ... We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid ...
Required Qualifications: * 1 years of experience in an office environment managing time-sensitive deadlines * 1 years of direct experience with Medicaid and Medicare provider enrollment
Required Qualifications: * 1 years of experience in an office environment managing time-sensitive deadlines * 1 years of direct experience with Medicaid and Medicare provider enrollment
Director(a) De Gestión Laboral
San Juan, PR · On-site
$120 - $170/hr
... Medicaid, Health Insurance Portability and Accountability Act (HIPAA), and organizational requirements by integrating regulatory expectations into workforce and quality management practices.
Director(a) De Gestión Laboral
San Juan, PR · On-site
$120 - $170/hr
... Medicaid, Health Insurance Portability and Accountability Act (HIPAA), and organizational requirements by integrating regulatory expectations into workforce and quality management practices.
Claims Examiner
Guaynabo, PR · On-site
$21/hr
Medicare, Medicaid, commercial insurance, or managed care ; Clinical documentation review Proficiency with: ICD-10-CM ; CPT ; HCPCS ; Medical terminology ; Anatomy and physiology ; EHR systems (such ...
Claims Examiner
Guaynabo, PR · On-site
$21/hr
Medicare, Medicaid, commercial insurance, or managed care ; Clinical documentation review Proficiency with: ICD-10-CM ; CPT ; HCPCS ; Medical terminology ; Anatomy and physiology ; EHR systems (such ...
Sales Promoter
Bayamon, PR · On-site
JOB SUMMARY Responsible for effectively promoting our managed care products designed for individuals eligible for Medicare and Medicaid. Responsible for participating in marketing events ...
Sales Promoter
Bayamon, PR · On-site
JOB SUMMARY Responsible for effectively promoting our managed care products designed for individuals eligible for Medicare and Medicaid. Responsible for participating in marketing events ...
Sales Promoter
Hatillo, PR · On-site
JOB SUMMARY Responsible for effectively promoting our managed care products designed for individuals eligible for Medicare and Medicaid. Responsible for participating in marketing events ...
New
Sales Promoter
Hatillo, PR · On-site
JOB SUMMARY Responsible for effectively promoting our managed care products designed for individuals eligible for Medicare and Medicaid. Responsible for participating in marketing events ...
New
PR · On-site
$18 - $24/hr
... Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. * And all other duties assigned by the manager and/or supervisor. Education: * Bachelor's degree in Health ...
Quick apply
PR · On-site
$18 - $24/hr
... Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. * And all other duties assigned by the manager and/or supervisor. Education: * Bachelor's degree in Health ...
PR · On-site
$16.75 - $20.25/hr
... and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. 8. In addition, all other duties assigned by the manager and/or supervisor. Education: * Pharmacy ...
Quick apply
PR · On-site
$16.75 - $20.25/hr
... and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. 8. In addition, all other duties assigned by the manager and/or supervisor. Education: * Pharmacy ...
Pharmacy Technician
$17.25 - $20.75/hr
... Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. * In addition, all other duties are assigned by the manager and/or supervisor. Requirements * Pharmacy ...
Quick apply
Pharmacy Technician
$17.25 - $20.75/hr
... Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. * In addition, all other duties are assigned by the manager and/or supervisor. Requirements * Pharmacy ...
PR · On-site
... Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. 12. And all other duties assigned by the manager and/or supervisor. Education: · Master's Degree in Clinic ...
Quick apply
PR · On-site
... Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. 12. And all other duties assigned by the manager and/or supervisor. Education: · Master's Degree in Clinic ...
PR · On-site
Revenue Cycle Management Specialist I Who are we? For more than 26 years, CorePlus has provided ... Medicaid). 4. Analytical Skills: Ability to analyze financial data, identify trends, and make data ...
Quick apply
PR · On-site
Revenue Cycle Management Specialist I Who are we? For more than 26 years, CorePlus has provided ... Medicaid). 4. Analytical Skills: Ability to analyze financial data, identify trends, and make data ...
PR · On-site
Revenue Cycle Management Specialist I Who are we? For more than 26 years, CorePlus has provided ... Medicaid). 4. Analytical Skills: Ability to analyze financial data, identify trends, and make data ...
Quick apply
PR · On-site
Revenue Cycle Management Specialist I Who are we? For more than 26 years, CorePlus has provided ... Medicaid). 4. Analytical Skills: Ability to analyze financial data, identify trends, and make data ...
PR · On-site
... Medicaid, Commercial, and Government Health Plan enrollees, over the telephone. This role supports clinical staff through the management and follow-up of non-clinical matters and general ...
Quick apply
PR · On-site
... Medicaid, Commercial, and Government Health Plan enrollees, over the telephone. This role supports clinical staff through the management and follow-up of non-clinical matters and general ...
Quick apply
PR · On-site
... Medicaid, Commercial, and Government Health Plan enrollees, over the telephone. This role supports clinical staff through the management and follow-up of non-clinical matters and general ...
Quick apply
PR · On-site
... Medicaid, Commercial, and Government Health Plan enrollees, over the telephone. This role supports clinical staff through the management and follow-up of non-clinical matters and general ...
Quick apply
Triple-S Management Job Location (Short): San Juan, PR Posting Start Date: 8/12/26 At Triple-S, we ... We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid ...
Triple-S Management Job Location (Short): San Juan, PR Posting Start Date: 8/12/26 At Triple-S, we ... We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid ...
PR · On-site
Basic knowledge of health insurance benefits (Medicare, Medicaid, commercial plans). * Proficiencyin technology tools and computer equipment. * Good keyboard management and data entry skills.
Quick apply
PR · On-site
Basic knowledge of health insurance benefits (Medicare, Medicaid, commercial plans). * Proficiencyin technology tools and computer equipment. * Good keyboard management and data entry skills.
PR · On-site
... Medicaid). 4. Analytical Skills: Ability to analyze financial data, identify trends, and make data ... Familiarity with healthcare management software, electronic health records (EHR), and billing ...
Quick apply
PR · On-site
... Medicaid). 4. Analytical Skills: Ability to analyze financial data, identify trends, and make data ... Familiarity with healthcare management software, electronic health records (EHR), and billing ...
Medicaid Manager information
What does a Medicaid Manager do?
A Medicaid Manager oversees the administration and management of Medicaid programs within a healthcare organization or government agency. They ensure compliance with federal and state regulations, manage budgets, supervise staff, and coordinate services to ensure eligible individuals receive appropriate healthcare benefits. Their role often includes developing policies, monitoring program performance, and collaborating with other departments or agencies to improve service delivery. Medicaid Managers play a critical role in optimizing program efficiency and ensuring quality care for beneficiaries.
What are the key skills and qualifications needed to thrive as a Medicaid Manager?
To thrive as a Medicaid Manager, you need expertise in healthcare administration, regulatory compliance, and Medicaid policy, often supported by a bachelor’s or master’s degree in health administration or a related field. Familiarity with Medicaid Management Information Systems (MMIS), data analytics tools, and relevant certifications such as Certified Professional in Healthcare Quality (CPHQ) are vital. Strong leadership, communication, and problem-solving skills help you effectively manage teams and navigate complex healthcare regulations. These skills ensure efficient program administration, regulatory adherence, and improved healthcare outcomes for Medicaid populations.
What are some common challenges a Medicaid Manager faces when coordinating with healthcare providers and state agencies?
Medicaid Managers often encounter challenges when aligning the diverse requirements of healthcare providers with the regulatory expectations of state agencies. Balancing compliance, timely claims processing, and communication between stakeholders can be complex, especially given frequently changing policies and high caseloads. Successful Medicaid Managers stay proactive by fostering strong relationships, staying up-to-date on policy changes, and implementing efficient workflows to minimize errors and delays. This collaborative approach is essential for ensuring quality care delivery while maintaining program integrity.
What is the difference between Medicaid Manager vs Medicaid Coordinator?
| Aspect | Medicaid Manager | Medicaid Coordinator |
|---|---|---|
| Credentials | Typically requires a bachelor’s degree in healthcare administration, social work, or related field; certifications like Certified Medicaid Planner may be preferred | Often requires similar educational background; certifications are less common but may include Medicaid-specific training |
| Work Environment | Works in healthcare organizations, government agencies, or insurance companies overseeing Medicaid programs | Usually works in healthcare facilities or community organizations assisting with Medicaid enrollment and compliance |
| Responsibilities | Oversees Medicaid program operations, manages staff, ensures compliance, and develops policies | Assists clients with Medicaid applications, explains benefits, and ensures proper documentation |
Medicaid Managers focus on overseeing Medicaid program operations and compliance, while Medicaid Coordinators primarily assist clients with enrollment and benefits. Both roles require similar educational backgrounds but differ in scope and responsibilities.
What are the most commonly searched types of Medicaid jobs in Puerto Rico?
The most popular types of Medicaid jobs in Puerto Rico are:
What job categories do people searching Medicaid Manager jobs in Puerto Rico look for?
The top searched job categories for Medicaid Manager jobs in Puerto Rico are:
Full-time
Re-posted 24 days ago
Job description
SUMMARY:
Responsible for assessing patient care needs and planning home health care services.
JOB DUTIES /KNOWLEDGE
- Coordinates, screens and assesses home health care needs of patients referred to Agency
- Completes intake process within established time parameters
- Collaborates with physicians, nurses and discharge planners to identify patient care needs and to establish the appropriate level of care for patients referred to the Agency
- Establishes and completes an individualized Plan of Treatment in accordance with MD orders, patient care needs, insurance guidelines and Agency protocol, including the identification of formal/informal supports in carrying out plan
- Ensures that the needed DME, medical supplies and ancillary services are ordered and documented
- Contacts managed care personnel when appropriate to obtain necessary initial authorizations
- Notifies referring party if patient will require alternative discharge plan
- Delegates specific tasks to support staff providing clear, timely direction to ensure continuity of care
- Serves as a resource to all persons contacting the agency for information
- Treats all referral parties, patients, family members and hospital staff courteously and in a non-discriminatory manner
- Demonstrates sound knowledge of reimbursement and billing practices for Medicare, Medicaid, managed care, charity care and other third-party payers
- Demonstrates cultural sensitivity
- Maintains patient confidentiality at all times
- Demonstrates working knowledge of State and Federal regulations
- Participates in Quality and Performance Improvement activities and in the orientation process for agency staff
- Performs other related duties as required
- Demonstrates a high degree of commitment to customer relations and quality service
- Utilizes community resources as appropriate to meet patient care needs
JOB PERFORMANCE
- Demonstrates ability to perform quality and effective services.
- Demonstrates ability to set and meet objectives, and to find increasingly efficient ways to perform task.
- Completes work, and documentation with accuracy and within agency time frames.
- Requires minimal supervision and is self-directed.
- Understands the delivery of service within home care.