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Why This Role is Important to UsAs a key part of the Legal Department, the Assistant General Counsel, Director ("AGC") will work closely with and support various internal departments including operations, procurement, finance, and marketing, in addition to the Legal and Compliance teams in connection with various transactional and regulatory matters.
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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 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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Detailed knowledge of all applicable health plan policies and procedures, MassHealth, the Health Connector, DOI regulations, Medicare regulations and Commercial product contractual obligations is a key element of this role.
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Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. 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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Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating procedures.
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8+ years of work experience or Paralegal Certificate and 6+ years of work experience in a law firm, an in-house legal department, a consulting firm, or comparable experience elsewhere. Reviews patent application files to check for compliance with USPTO requirements and department standards, takes initiative to resolve discrepancies.
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Reporting to the CMRS Manager, the Case Management Resource Specialist (CMRS) works collaboratively with the Discharge Planning RN Case Managers; providing direct administrative support to the discharge planning processes and to the department.
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Work with Finance and Billing to establish a system to approve all pre-transplant charges for inclusion on the Medicare cost report. Completes Medicare time studies in a timely manner for inclusion on the Medicare cost report.
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4+ years of relevant work experience as a lawyer at a law firm and/or corporate legal department. Reporting into the VP, Legal - Corporate and ESG, you will help support general corporate legal and public company matters and other projects within the Dynatrace Legal Team and also provide in-depth counsel and legal advice on a wide range of compliance matters.
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The Associate will join the Legal Entity Controllers team in the Boston, MA office, which currently is a hybrid working model. Berwyn/Wayne : For Pete’s Sake, Chester County Food Bank, Habitat for Humanity Chester County, Brandywine SPCA, as well as others.
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Good understanding of all associated relevant legal, compliance, and regulatory requirements. The Market Access department is comprised of Health Economics and Outcomes Research (HEOR), Channel Management and Contract Operations, Market Access Marketing and Payer Field Team, and Patient and Reimbursement Services and Field Teams.
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The selected candidate will report to the Undersecretary & Chief of Staff and will collaborate with policy, legislative affairs, fiscal, legal, and communications staff at EOE and its agencies-the Department of Early Education and Care, Children's Trust, the Department of Elementary and Secondary Education, and the Department of Higher Education.
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Reporting to the SVP, Sales & Client Management, the Director, Group Medicare Sales, is an integral member of the leadership team-driving BCBSMA's purposeful re-entry into the Group Medicare Advantage Market.
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As a prosecutor, defense attorney, or victim's legal counsel you will litigate felony and misdemeanor criminal cases before military judges and juries. As you gain experience, you may eventually transition to other areas of law, such as Civil Law, Administrative Law and Legal Assistance, or act as in-house counsel to Marine Corps headquarters staff.
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medicare legal department jobs Title: compliance specialist Company: Metroplus Health Plan in Somerville, MA
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