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The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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Experience leading appeals and grievances for Commercial, Medicaid and Medicare products and plans preferred. The Grievance and Appeals Coordinator will also present cases to the Appeals Committee.
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The attorneys will be responsible for conducting jury and non-jury trials, as well as oral arguments before the Commonwealth's state trial courts, the Massachusetts Appeals Court, the Supreme Judicial Court, Federal District Courts, and the First Circuit Court of Appeals, with the majority of cases filed in Boston or in contiguous counties.
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As necessary, assists the Housing Appeals Committee Docket Clerk with various miscellaneous administrative tasks, such as scheduling, maintenance of dockets and files, preparation of record on appeal for the Office of the Attorney General.
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Accountable for understanding federal and state health care law requirements applicable to CCA, including Medicare and Medicaid rules, HIPAA privacy and security, healthcare reform, legal and regulatory topics relating to CCA's status as a government contractor and integrated health care services delivery organization, Accountable Care Organization requirements, and insurance and managed care regulatory requirements.
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The Commonwealth of Massachusetts received a waiver from the Centers for Medicaid and Medicare to improve the ways in which MassHealth provides care to its members. Haitian Creole-Speaking Nutrition Services Coordinator.
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The TNC Counsel I (Hearing Officer) will be primarily responsible for managing and developing a caseload of appeals from rideshare drivers denied by the Division to drive for a rideshare company.
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Under the guidance of the Associate Director of Development, support the Annual Fund by writing strategic, donor-centric digital and print appeals for the Direct Mail, Champions Circle (monthly donors), Online Giving, and Giving Tuesday campaigns that will help us reach our Annual Fund goal of $1.25M by 2020.
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Knowledge of Medicaid Drug Rebate Statute, Veterans Health Care Act, Average Sales Price, and 340B program. Engage with senior commercial leaders in a broad range of areas outside of market access such as sales, medical, regulatory, operations, finance, supply chain, manufacturing, pharmacovigilance, external affairs, and other functions.
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Effectively communicate and appropriately collaborate with the Market Access team to ensure strategic alignment and effective implementation of the clinical strategy for National and Regional Managed Care accounts, covering all books of business (e.g., Commercial, Managed Medicaid, Fee-for-Service, Medicare, PBMs, and Exchange Plans.
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Work with Director of Annual Giving to develop opportunities to leverage alumni volunteers for phone campaigns, direct mail appeals and e-solicitation materials with tailored message for young alumni.
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Manage a broad range of regulatory and compliance matters, including issues related to the Anti-Kickback Statute, Stark Law and/or False Claims Act, Medicare and Medicaid reimbursement, data privacy, drug diversion, licensing, research compliance, telehealth, and general compliance and risk management.
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The agency provides representation in criminal, delinquency, youthful offender, child welfare, guardianship, mental health, sexually dangerous person, and sex offender registry cases, as well as in appeals and post-conviction and post-judgment proceedings related to those matters.
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Understanding of healthcare economics and various lines of business (i.e., Medicare Fee-for-service; Medicare Advantage, Commercial, Managed Medicaid, Medicaid Fee-for-service, unfunded, etc.
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Patients presenting for services, by appointment or walk-in, will be screened for eligibility and offered enrollment assistance to secure insurance coverage through MassHealth, Out of State Medicaid, HSN, or BMC’s Charity Care Program.
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