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You should have an understanding of regulations impacting digital products such as FCC (TCPA, CANSPAM), FTC, State Unfair Competition Laws; familiarity with EEOC/ADA/GINA, ERISA, HIPAA, Medicare/Medicaid a plus.
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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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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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4+ years proven background in healthcare law (contract law, Medicaid, Medicare, CMS standards, federal contracting, procurement, value-based care, QIA, and healthcare transactions.) This position will also serve as a subject matter expert, educational resource, and strategic adviser, to Sharecare business leaders and colleagues on all aspects of governmental healthcare programs including Medicaid, Medicare, and value-based care.
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Under the direction of the Director of Facilities Management, this position is responsible for all regulatory compliance documentation relating to Joint Commission, Center for Medicaid and Medicare Services (CMS), Fire Department, Insurance Carrier, etc.
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Our client, a mutual benefit corporation headquartered in Oakland, providing health, dental, vision, Medicaid and Medicare healthcare service plans in California seeking an accomplished DevSecOps Engineer.
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Experience in provider enrollment and Medicaid programs. Assists RCM in billing issues as it relates to Medicare and Medicaid provider numbers. Responsible and leads key projects related to licensing/Medicare/Medicaid processes, adverse sanctions, and disclosures of ownership related to applications.
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Assist clients to become self-sufficient in navigating and utilizing transportation resources such as Medicaid taxi and Marta bus system. Assist clients to resolve any issues that arise concerning billing for medical services and coordination between Medicaid or other insurance plans and health providers.
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Knowledge and experience with Medicaid, managed care, MMIS, health claims payment and processing, population health management, or other similar areasHighly desired. The Georgia Department of Community Health (DCH) is in the process of transforming existing legacy Medicaid Enterprise Systems (MES) into modern, loosely coupled, seamlessly integrated, modular systems where the exchange of data and processes is seamless and automatic.
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Customizes the PRA for pediatric clinical research studies, utilizing Medicaid, Georgia statutes, and/or other reliable sources. Applies the Centers for Medicare & Medicaid National Coverage Determination (NCD) 310.1, Routine Costs in Clinical Trials, to determine if the study is a qualifying clinical trial with therapeutic intent, diagnosed disease, Medicare benefit category, and deemed status or seven desirable characteristics.
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Deliver clinical practice advice as part of the DBHDD program policy or support teams responsible for interpreting applicable laws, regulations and policies regarding highly complex issues in MEDICAID administered programs.
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Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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Substantive experience with federal criminal practice or government investigations, including matters related to the False Claims Act, Anti-kickback statute, Medicare and Medicaid compliance, OIG/DOJ investigations, and healthcare fraud, is advantageous for this role.
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The role will be focused on negotiating value-based care contracts with health plans for their commercially insured members (not those covered by Medicare Advantage or Medicaid). Passionate about driving the shift from fee-for-service to value based care.
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Contacts state regulatory agencies (including state sales, tax and business offices, Departments of Health or equivalent, Medicaid and Medicare intermediaries, and Secretary of State Offices) to determine regulations required to establish licensure.
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medicaid job in Atlanta, GA
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