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Research, analyze, and interpret state Medicaid and government program policies, including Medicaid Fee‑for‑Service, Medicaid Managed Care Organizations, the Children’s Health Insurance Program, and state waiver programs
Monitor state and payer documentation such as provider manuals, State Plan Amendments, bulletins, and regulatory communications
Track legislative and regulatory developments across states and identify trends, risks, and opportunities affecting cardiology services
Evaluate operational, financial, and compliance impacts of payer policy changes and prepare summaries and briefs for leadership
Partner with internal teams to embed payer policy requirements into billing, coding, credentialing, and reimbursement workflows
Identify compliance risks related to policy changes and recommend mitigation strategies
Serve as a resource for interpreting payer rules related to coverage, coding, reimbursement methodologies, and documentation standards
Support audits, appeals, payer disputes, and policy‑driven operational initiatives as needed
Requirements
Associate degree required
bachelor’s degree preferred
Minimum 4 years of experience in healthcare reimbursement, payer policy, or health plan administration
Strong knowledge of state and federal healthcare laws, rules, and regulations
Working knowledge of Medicaid Fee‑for‑Service, Medicaid Managed Care Organizations, the Children’s Health Insurance Program, disability waivers, and other state government programs
General understanding of provider credentialing and enrollment requirements
Strong analytical skills, exceptional communication, attention to detail, and the ability to manage multiple projects in a dynamic regulatory environment
Nice to have
Familiarity with Current Procedural Terminology codes and independent diagnostic testing facility operations preferred
Familiarity with payer policy databases and third‑party billing tools preferred
What we offer
Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
Educational assistance programs
Time-off benefits such as paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, and paid parental leave