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The Director, MA & Medicaid Contracting on the Strategic Payer Partnerships team will execute Aledade's Medicare Advantage and Medicaid value-based care contracts with national and regional health plans as we help primary care providers shift into value-based care.
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Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. Physical Therapist Assistant Home Health Care: One year experience in supervised clinical practice in acute care or rehab setting preferred.
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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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The role will be focused on negotiating value-based care contracts with health plans for their Medicare Advantage and Medicaid members. Negotiate and renegotiate MA & Medicaid value-based care contracts with prospective payer partners, which may include: proactively engaging with payer partners to improve terms, reading contracts, setting contract terms, tracking deliverables, interfacing with internal teams, compiling data, reporting updates and executing value-based care contracts for Medicare Advantage & Medicaid members/patients.
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Officially we title this job a BOM or Business Office Manager, but in other centers it may be called a Medicare / Medicaid Biller or Accounts Receivable Coordinator or even a Financial Services Rep. This is NOT a remote / 'work from home' position.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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If employed at one of our senior living communities that receives Medicare or Medicaid funding, team members must not be considered an “Excluded Party” as defined by the U.S. Department of Health and Human Services, any state Medicaid Programs, and any additional federal and state government contract programs.
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Serve as in-house legal counsel on issues that affect drug coverage and reimbursement for biopharmaceutical companies in various federal health care programs such as Medicare fee for service, Medicare Advantage (Part C), the Medicare Prescription Drug Benefit (Part D), and the 340B Drug Discount Program.
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Regulatory Knowledge: Extensive knowledge of third-party payer regulations and contracts, including Medicare, Medicare Advantage, Medicaid, and non-governmental payers. The ideal candidate will possess a deep understanding of third-party payer regulations and contracts, including Medicare, Medicare Advantage, Medicaid, and non-governmental payers.
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Experience in health care, health plans, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect.
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As the Vice President of Payer Contracting Strategy within the Business Development team, you will lead and execute the Companys payer contracting strategy, including, but not limited to, Commercial, Medicare Advantage, and Medicaid plans, and oversee the development of new initiatives to enhance payer value and alignment for value-based care programs.
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Experience in Risk-based arrangements and Value-Based care in government services (Medicare Advantage, Medicaid, ACA)Proven negotiation skills including extensive experience leading Medicare advantage percent of premium/delegation dealsAbility to manage multiple priorities, and leading multiple complex negotiations at a timeAdept at execution and delivery (planning, delivering, and supporting) skillsExperience working in a highly matrixed environment.
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Knowledge in the following areas:Reimbursement functions: Subject matter expert on CMS cost reporting, disproportionate share (DSH), Uncompensated Care, Bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, Ohio Medicaid, HCAP, UPL and Franchise Fee programs.
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1+ years of experience in medical records coding (HCC Coding) with knowledge of Medicare, Marketplace, and Medicaid risk adjustment is required. 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding.
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The Director is accountable for the effective direction and management of ARHs Accountable Care Organization, ARH CMS Bundled Payment Initiatives, Future Provider Medicare Advantage Plans, and Medicaid Reimbursement Programs.
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medicare medicaid advantage jobs Title: coordinator Company: Fenton Healthcare Center
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