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Work on issues related to Medicare coverage determinations, Medicaid coverage and preferred drug list determinations, FDA drug development and safety policies, agency guidance policies related to patient engagement and diversity equity and inclusion (DEI) impacting health access, clinical trials, and research opportunities.
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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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The LTSS/SAI National Senior Medical Director, reporting to a Regional CMO of Medicaid, will collaborate with Aetna National Medicaid, Regional and health plan leadership to identify, develop, implement, and evaluate the effectiveness of key LTSS strategic initiatives including trends, policies and programs, designed to drive the delivery of high value healthcare supporting a sustainable competitive business advantage for Aetna LTSS members.
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Regional VP, Operations Medicaid. Experience in strategic and thought leadership in supporting Medicaid health plans. They will be responsible for the strategic development and oversight of operations for Humana's Oklahoma Medicaid Plan. They will manage ongoing operations across multiple levels of the organization to meet operational Contract requirements and financial performance goals.
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Apply Now For Free Regional VP, Operations Medicaid. Location : Tulsa, OK Job InformationHumanaRegional VP, Operations MedicaidinTulsaOklahomaDescriptionThe Chief Operating Officer (COO) establishes long-range goals, objectives, and plans and monitors financial and operational performance.
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We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Assist the FHIMD with leading and managing facility-based HIM operations and staff including, but not limited to, record pick up and reconciliation, release of information request processing, hardcopy retrieval of medical records, processing of birth certificate/paternity, document imaging (prepping, scanning and indexing), physician chart completion and unbilled activities.
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Because school corporations are atypical Medicaid providers, the IDOE School Medicaid Specialist provides public policy research, support for Medicaid coverage and reimbursement, and technical assistance for public school corporations that voluntarily participate in Medicaid claiming.
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As such, FCS is a fee-for-service program funded by a Medicaid Third Party Administrator, and subject to federal and state reporting requirements. Catholic Community Services’ Foundational Community Supports (FCS) program provides Supportive Housing and Supportive Employment Services under the Medicaid Transformation Project.
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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) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits.
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Ensures compliance with the FAI, Medicare PPS, Medicaid and Managed Care processes and are managed within the requirements for reimbursement, regulatory and accreditation requirements. Participates in meeting and conducts rounds with the Administrator and Regional Director of Operations.
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Responsibilities Area of Focus: Kansas Client Success Partners are integral members of PCG’s Medicaid School-Based Services (SBS) program; the specific focus of this role will be on the Fee-for-Service (FFS) program.
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Establishes relationship with FSSA personnel, Medicaid Personnel and Insurance leaders and their provider support personnel to ensure they understand our needs. This position will also oversee the Managed Care Team -who provides Prior Authorizations to the Field, along with doing all paperwork to maintain our 3^rd^ party payers enrollment and updates (Medicaid, Medicare and Insurance contracts) and keeping our System for Award Management (SAMs) updated that is required for our VA/VCA contracts.
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As one of only five managed care organizations (MCOs) contracted with the Washington State Health Care Authority for Medicaid, and the only not-for-profit, regional based MCO, CHPW takes its responsibility to the community seriously by embedding the values of health equity and whole-person care in all programming and decision-making.
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Income (employment, SSI/SSDI benefits)Insurance (Medicaid, Medicare, private)Temporary (local shelters, family/friends) and permanent housing (fair market rate, Permanent supportive housing, section 8/public housing, etc.
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Experience in provider network management, Medicaid/Medicare contracting, and/or claims processing preferred. Experience in provider network management, Medicaid/Medicare contracting, and/or claims processing preferred.
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medicaid job in Tulsa, OK
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