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Assist the Civil Division with appeals work, including writing and editing appellate court briefs, defending clients at oral argument when scheduled, and helping other attorneys in the office by preparing appeals and arguments.
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Your training will enable you to interview witnesses, research court decisions and Army regulations, process legal claims and appeals, and prepare records of hearings, investigations, courts-martial, and courts of inquiry.
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Assist in the preparation and drafting of testimony, regulatory comments, and position statements sent to legislative and regulatory bodies and other interested parties concerning legislation, policies, published reports, regulations, and statutes governing Medicaid, long-term services and supports (LTSS), and other waiver programs.
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Medicaid and Medicare Federal Regulations, State Statute, Rules, and Policies applicable to AHCCCS programs. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.
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Senior Reimbursement Analyst i*s responsible for providing cost report preparation, cost report appeals, audit preparation and other duties related to the regulatory reimbursement services of Dignity Health.
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The Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS, ALTCS, Medicaid and Medicare Regulations.
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Active registration or eligible to register with the Drug Enforcement Agency (DEA) Active Medicare/Medicaid enrollment or be eligible to enroll. Lead a team caring for complex, value-based care (VBC) patients to include: Advanced Practice Providers, Social Workers, Clinical Pharmacists and Coordinators.
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For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.
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The Center for Medicare and Medicaid (CMS) is launching a new value-based care program to disrupt Traditional Medicare, and we believe that this represents an opportunity to achieve the meaningful change we envision.
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AHCCCS program design and implementation, prior authorization functions and responsibilities, provider network, and funding source. Collaborate with AHCCCS providers including SMI clinic, TRBHA, Medical Home or other treatment team members in order to provide technical assistance, training, & consultation on As needed, provides backup for the responsibilities held by the BH Prior Authorization/Utilization Review unit & other CMSU functions as needed.
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The Reimbursement Analyst is responsible for providing cost report preparation, cost report appeals, audit preparation and other duties related to the regulatory reimbursement services of Dignity Health.
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Strong knowledge in community LTSS programs, including HCBS waivers such as 1915(c), 1915(i), 1915(j), and 1915(k), along with Medicaid State Plan benefits, PACE, SNFs, and ICF-IID. Knowledge must include federal laws and regulations governing the programs.
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Communicates to Utilization Management Nurse data supporting denial appeals, or notification of potential denials. Reviews and analyzes third-party payer denials for in house patients, and communicates to attending physician , Case Management, Manager, Utilization Management Medical Director, and Utilization Management Nurse as per department protocols.
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This position will investigate and prosecute various types of AHCCCS fraud cases including, but not limited to, involving the falsification of medical records and the filing of false or inflated Medicaid billing claims; thefts and embezzlements from AHCCCS clients and health care institutions; the illegal diversion of prescription drugs by health care providers; and the physical, sexual, and emotional abuse of residents being cared for in AHCCCS-funded facilities.
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AHCCCS and Medicaid regulations, policies, and procedures and applicable federal and state statutes, regulations and rules. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities.
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appeals medicaid jobs in Phoenix, AZ
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