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The State of Nebraska, DHHS, is hiring for a DHHS Program Coordinator in the Division of Medicaid and Long-Term Care, with the State Unit on Aging. Consult and review Long-Term Care Ombudsman Program cases upon request and provide guidance on legal issues and provide training to state and local ombudsman and AAA staff on legal issues.
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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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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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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 federal regulations including COBRA, Advance Directives, Medicare, Medicaid, Joint Commission, OSHA and HIPAA as they relate to hospital intake and payment for services. Performs outbound calls to complete pre-registration process for all pre-scheduled admissions and appointments.
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Ability to clinically supervise, appropriate delegate responsibility and maintain required State and Centers for Medicare and Medicaid Services (CMS) required supervision criteria for Physical Therapist Assistants, PT/OT Technician, support staff and students in the provision of physical therapy activities.
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Extensive experience in healthcare contracting, with a critical understanding of PBMs, National Health Plans, Medicare Part D/B, GPOs, VA/DoD, Medicaid, and the evolving market landscape. Minimum of 12 years of pharmaceutical industry experience, with significant expertise in at least two of the following areas: Channel Strategy, Finance, Pharmacy, Pricing, Trade, or Market Access.
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You'll be responsible for: Reviewing and screening provider enrollment applications for Nebraska Medicaid. Staying updated on the Nebraska Medicaid Provider Enrollment and Screening Project, including relevant policies and procedures.
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Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQNational Committee for Quality Assurance, and ERISEmployee Retirement Income Security Act of 1974.
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Serves as a case manager for children ages birth to 3 who qualify for Medicaid Waiver. Serves as a case manager for children ages birth to 3 who qualify for Medicaid Waiver. Find services to meet developmental, educational, financial, healthcare, child care, respite care, and other services to meet their needs.
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Providing sound, practical judgment in the interpretation and application of relevant laws and regulations, including the Anti-Kickback Statute, the Beneficiary Inducement Statute, Medicare/Medicaid, False Claims Act, Stark Law, HIPAA and state health information privacy laws, and marketing and advertising laws applicable to the marketing and promotion of medical products.
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Maintain knowledge of payer coverage determinations and guidelines, including FQHC requirements for Medicaid payers and Medicare. Job DescriptionJob DescriptionPosition Summary: The Revenue Cycle Manager will oversee all the functions of the billing office, including policies and procedures.
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The Procedures Coordinator is responsible for performing work pertaining to the procedural and administrative needs of MAP/HC Procedures by staying abreast of the Department of Health policy changes to ensure that Medicaid eligibility factors are correctly stated, using plain language text so that forms can be easily understood by staff and clients.
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Responsible for all aspects of billing – Medicaid, private insurance, HHS contracts, all Federal, State and privately funded grants, Title XX, etc. Responsible for all aspects of billing – Medicaid, private insurance, HHS contracts, all Federal, State and privately funded grants, Title XX, etc.
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Provides information to Senior/client/families regarding financial concerns, including general information regarding Medicare, Medicare Part D, and application for Medicaid and other financial assistance programs.
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medicaid job in Lincoln, NE
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