Category: Curator- Job Hunter

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• Staff VP Medicaid Risk Adjustment
  

 
 

• Job Family: Business Support
  
• Type: Full time
  
• Date Posted:Jan 18, 2023
  
• Req #: JR48772
  

Location:

• IN, Indianapolis
  
• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
  

Description

Staff VP Medicaid Risk Adjustment

Location: Any US Location

Responsible for designing, implementing and directing programs and initiatives related to Medicaid Risk Adjustment. Accountable for the accuracy and completeness of risk scores for the health plan.

Primary duties may include, but are not limited to:

• Designs programs, policies and procedures related to risk adjusted revenue.
  
• Manages coding and auditing.
  
• Communicates best practices and opportunities for improvement.
  
• Collaborates with senior management to develop strategies and tactics that improve the accuracy of risk scores and reduce payment error risk.
  
• Monitors established operations, tracks performance, and resolve deficits.
  
• Evaluates, contracts, and manages vendors.
  
• Collaborates with senior leaders to drive business decision.
  
• Sets strategic direction for risk adjustment at the corporate and regional levels.
  
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  

Qualifications

Requires a BA/BS and minimum of 10 years experience with healthcare economics and/or risk adjustment; or any combination of education and experience, which would provide an equivalent background.

Preferred knowledge, skills, and experience:

• Risk adjustment operations and data analysis experience.
  
• Medicaid risk adjustment helpful, but not required.
  
• Demonstrated leadership skills and experience.
  
• Ability to demonstrate competencies in business acumen, strategic thinking, influencing, and executive presence.
  
• CPC or CCS-P certification.
  

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $ $175,120 to $ $315,216.

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
  

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at ~~~. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ~~~ for assistance.

EEO is the Law

Equal Opportunity Employer / Disability / Veteran

Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

• EEO Policy Statement
  
• EEO is the Law Poster
  
• EEO Poster Supplement-English Version
  
• Pay Transparency
  
• Privacy Notice for California Residents
  

Elevance Health, Inc. is an E-verify Employer

Need Assistance?

Email us (~~~) or call ~~~

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Neighborhood Health Association – Responsible for providing excellent customer service in delivering education, outreach and in-person assistance to patients to obtain Medicaid and/or other health coverage and benefits. Identify patient needs, screens for eligibility and provides assistance in obtaining resources through application process. Coordinates with team members to provide complete and positive services for the patients.

Duties and Responsibilities:
Meet with patients to identify relevant financial assistance resources and or payor sources. May provide assistance at various locations, including NHA clinic locations and community events.
Screens patients/clients for eligibility for entitlement programs and assists patients/clients in completing necessary applications to obtain the resources
Qualify applicable patients/clients for the appropriate health benefits. Ensures forms are fully completed and submitted in a timely manner and information is accurately entered into Patient Management System
Coordinates the provision of services provided to the patient/client including scheduling appointments in the Patient Management System
Call uninsured or underinsured patients who may qualify for health benefits to discuss possible benefit options and to offer assistance where needed.

Skills/Qualifications:
A high school diploma or equivalent, bachelor’s degree is preferred
Minimum 2 years of working with health insurance products, including Medicaid enrollment
Knowledge of current public coverage programs, including extensive knowledge of Medicaid
Ability to communicate effectively written and verbally, face-to-face and over the phone
A valid Ohio Driver’s License and auto insurance with an acceptable driving record. Reliable transportation and willingness to travel throughout Lucas County
Knowledge of basic computer programs (Microsoft Office Suite)
Ability to work closely and effectively as a team player with NHA staff, community leaders, and health professionals
Be required to keep up to date on any changes regarding Medicaid applications
Possess a strong desire to carry out and promote the mission and vision of Neighborhood Health Association

Full-time Monday – Friday, no evenings, weekends, or holidays.

We offer a competitive salary and benefits package including Health, Dental, Vision and Life Insurance, a matching retirement plan, Employee Assistance Program, 11 paid holidays and generous PTO.

Please provide your salary requirements when you apply to be considered for an interview for this position.

Neighborhood Health Association (NHA), a Federally Qualified Health Center (FQHC), is the largest community health center system in Northwest Ohio with partnerships that include ProMedica, Mercy Health, and University of Toledo Medical Center. NHA has grown from a single location in 1969 to 12 medical and dental clinics throughout Lucas County. Today we operate multiple health centers including pediatrics, adult medicine, dental services, health care for the homeless, women’s health center, senior centers, and a full-service pharmacy with lab services on site.

For more than 50 years, NHA has placed a strong focus on prevention and empowering individual responsibility in managing their health care and overall well-being. Our services are acutely responsive to the needs of everyone throughout the communities we serve, providing excellent care and the best health practices.

Our Mission: Through our exceptional health care services, we empower and educate, aggressively working to eliminate health care inequities, while supporting personal responsibility for one’s own health regardless of the ability to pay.

We are a drug free workplace, and an Equal Opportunity Employer

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•  

General Dynamics Information Technology • Fairfax, VA 22037

Job #2423139076

•  
• Type of Requisition: Regular
  

Clearance Level Must Be Able to Obtain: None

Job Family: Research

GDIT is searching for a dynamic Medicare Advantage/Risk Adjustment Subject Matter Expert to join our growing team. You will support an exciting new program focused vulnerability risk assessments for the Centers for Medicare & Medicaid Services. The role will allow you to utilize in-depth knowledge of Medicare and/or Medicaid Managed Care policies, payment structures, risk adjustments processes, including claims and data analyses. You will conduct and document advanced research and analyses to perform risk assessment of Medicare Advantage or Medicaid Managed Care vulnerabilities to quantify and priority risk and provide recommendations for mitigation strategies to reduce or prevent future risk.

Required Skills:

• Bachelor’s degree and 5+ years of Healthcare Policy experience (or equivalent combination of education and experience)
  
• Experience documenting and presenting complex studies and analyses to a wide audience including senior leadership
  

Desired Skills:

• 5 years conducting regulatory or policy research related to Medicare and/or Medicaid. Medicare Advantage or Medicaid Managed Care experience is preferred.
  
• Strong interpersonal and communications skills, both written and oral
  
• Proficient in computer skills, e.g. Microsoft Office-Word, Excel
  
• Ability to conceptualize, solve problems and draw conclusions
  
• Highly organized, ability to multi-task and meet deadlines
  

#GDITHealthSystems

COVID-19 Vaccination: GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.

Clipped from: https://www.linkedin.com/jobs/view/oag-sergeant-sergeant-oag-medicaid-fraud-control-unit-23-0420-at-texas-attorney-general-3440865727/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Please paste the following URL into a browser to view the entire job posting in the CAPPS Career Section: https://capps.taleo.net/careersection/ex/jobdetail.ftl?job=00029812 You may apply to the job directly through the CAPPS Career Section. It is not necessary to apply both through Work In Texas and CAPPS Career Section\ \ GENERAL DESCRIPTION Performs advanced criminal investigations of Medicaid provider fraud and nursing home related investigations for the Office of the Attorney Generals Medicaid Fraud Control Unit (MFCU). Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. OAG employees enjoy excellent benefits along with tremendous opportunities to do important work and make a positive difference in the lives of all Texans. JOB POSTING NOTICE Applicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check. The MFCU works cases jointly with other law enforcement agencies including the FBI, U.S. Department of Health and Human Services – Inspector General and IRS. In certain cases, it is necessary for our staff to have a Top Secret security clearance in order to fully participate in joint investigations or in task force activities. Top Secret clearances are not required prior to employment but in certain cases may be required at a later date. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment. Level of Supervision of State Classification: Works under limited supervision, with moderate latitude for the use of initiative and independent judgment. ESSENTIAL POSITION FUNCTIONS Conducts complex criminal investigations of Medicaid provider fraud, and/or assures that nursing home related investigations are addressed professionally and in a timely manner, utilizing a wide range of techniques, with the goal of accomplishing the primary mission of MFCU, bringing violators of state and federal law, over which MFCU has jurisdiction, to justice, and identifying Medicaid and Medicaid related overpayments to Medicaid providers Plans, participates in and conducts undercover investigations, surveillance operations, raids, and searches; identifies, gathers, and examines evidence, including complex records of Medicaid providers; executes court orders, warrants, and subpoenas; and reports investigative findings Establishes and maintains liaison with outside agencies, associations, groups, and the like whose assistance and cooperation can enhance the mission of MFCU, including but not limited to proactive generation of investigative targets; participates willingly in team investigative endeavors (intra-Team, inter-Team, inter-city, and inter-agency); and contributes to a positive work environment and high morale May train, lead, and/or assist with the work of others. Performs related work as assigned Responds to emergency situations by serving on-call twenty-four hours per day/seven days per week Maintains relevant knowledge necessary to perform essential job functions Attends work regularly in compliance with agreed-upon work schedule Ensures security and confidentiality of sensitive and/or protected information Complies with all agency policies and procedures, including those pertaining to ethics and integrity Qualifications: MINIMUM QUALIFICATIONS Education: Graduation from high school or equivalent Education: Sixty credit hours from an accredited college or university; may substitute an associates or bachelors degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis Experience

 
 

Four years full time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer TCOLE certification Knowledge of TCOLE training requirements and healthcare fraud investigation training needs Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook) Knowledge of criminal investigative principles, techniques, and methodologies Knowledge of management and administrative principles, techniques, and methodologies Knowledge of agency goals, objectives, rules, regulations, policies, and procedures Knowledge of state and federal statutes, rules, and regulations pertaining to law enforcement activities Knowledge of criminal and civil court proceedings and rules of evidence Skill in effective oral and written communication (Writing sample will be required at time of interview, if selected) Skill in researching and interpreting complex rules and regulations Skill in applying investigative techniques and procedures Skill in handling multiple tasks, prioritizing, and meeting deadlines Skill in exercising sound judgment and effective decision making Ability to develop and implement strategic plans and budgets Ability to use and care for firearms Ability to use intermediate impact weapons and Oleoresin Capsicum spray Ability to use physical tactics Ability to conduct complex criminal investigations of Medicaid provider fraud and nursing home related investigations Ability to interpret and apply applicable provisions of the Texas Penal Code, the Texas Code of Criminal Procedure, and federal statutes pertaining to investigations Ability to interpret and apply department policies and procedures Ability to plan, assign, and supervise the work of others Ability to handle stressful situations Ability to receive and respond positively to constructive feedback Ability to work cooperatively in a professional office environment Ability to provide excellent customer service Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave) Ability to arrange for personal transportation for business-related travel, with reimbursement Ability to work more than 40 hours as needed and in compliance with FLSA Ability to lift and relocate 30 lbs. Ability to travel (including overnight travel) up to 20% Ability to achieve 64% or better of VO2 max on the 2000-meter row, or meet a minimum score of 64% on the 500-meter row test or 4-minute row test, utilizing a Concept 2 Rower PREFERRED QUALIFICATIONS Experience conducting white collar/economic crime investigations Experience investigating healthcare provider fraud and working with state and federal prosecutors in criminal matters Accomplished practitioner of the MFCU documentation and report writing system or a like system Knowledge of healthcare fraud statutes (state and federal) TO APPLY To apply for a job with the OAG, electronic applications can be submitted through either CAPPS Recruit or Work in Texas. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code. Military Crosswalk information can be accessed athttps://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_LawEnforcement.pdf

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Travel Required: Less than 10%

Requisition Type: Regular

GDIT is searching for a dynamic Medicare Advantage/Risk Adjustment Subject Matter Expert to join our growing team. You will support an exciting new program focused vulnerability risk assessments for the Centers for Medicare & Medicaid Services. The role will allow you to utilize in-depth knowledge of Medicare and/or Medicaid Managed Care policies, payment structures, risk adjustments processes, including claims and data analyses. You will conduct and document advanced research and analyses to perform risk assessment of Medicare Advantage or Medicaid Managed Care vulnerabilities to quantify and priority risk and provide recommendations for mitigation strategies to reduce or prevent future risk.

Required Skills:

• Bachelor’s degree and 5+ years of Healthcare Policy experience (or equivalent combination of education and experience)
  
• Experience documenting and presenting complex studies and analyses to a wide audience including senior leadership
  

 
 

 
 

Desired Skills:

• 5 years conducting regulatory or policy research related to Medicare and/or Medicaid. Medicare Advantage or Medicaid Managed Care experience is preferred.
  
• Strong interpersonal and communications skills, both written and oral
  
• Proficient in computer skills, e.g. Microsoft Office-Word, Excel
  
• Ability to conceptualize, solve problems and draw conclusions
  
• Highly organized, ability to multi-task and meet deadlines
  

#GDITHealthSystems

The likely salary range for this position is $100,000 – $150,000, this is not, however, a guarantee of compensation or salary; rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

View information about benefits and our total rewards program.

 
 

About Our Work

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

COVID-19 Vaccination

GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.

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Duties

 
 

• Directs the work of a diverse staff of employees who develop business, technical and system requirements and manage information systems to operationalize Part B and Part D drug negotiation and inflation rebates.
  
• Manages and directs the development of processes and systems to collect manufacturer agreements and manufacturer data and to support the inflation rebate and negotiation processes.
  
• Manages the development of and review of technical briefing papers, talking points, testimony drafts, and presentations
  
• Represents the division in consultations in consultations with the local, state, and U.S. government officials, and the public regarding system requirements to operationalize Part B and Part D drug negotiations.
  
• Attend meetings and conferences with CMS staff and serve as a source of background data on the basis of research performed in preparation for the meetings and conferences.
  

 
 

Requirements

 
 

Conditions of Employment

 
 

• You must be a U.S. Citizen or National to apply for this position.
  
• You will be subject to a background and suitability investigation.
  
• This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.
  

 
 

Qualifications

 
 

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-15, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-14 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Directing or leading the development of business requirements for data management systems; (2) Directing or leading the development of policies, regulations, or procedures for health care programs; and (3) Overseeing the work of subordinate employees or team members.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Click The Following Link To View The Occupational Questionnaire


Education


This job does not have an education qualification requirement.


Additional information


Bargaining Unit Position: No


Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not required


This position will be in direct support of the Inflation Reduction Act of 2022. This Act increases healthcare spending by nearly $100 billion, mainly by extending the American Rescue Plan’s temporarily-expanded Affordable Care Act (ACA) premium tax credits for an additional three years, through 2025. The bill will also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer discount program, impose inflation rebates for Part B and Part D drugs, and other miscellaneous changes in Part B and Part D to improve the affordability of prescription drugs.


To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.


Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy.

• A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding.
  
  
  

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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Overview

 
 

About Public Consulting Group

 
 

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide—all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

 
 

Responsibilities

 
 

The Medicaid marketplace is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, schedule, , quality, , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise Systems (MES) experience and thought leadership

 
 

Specific Responsibilities

 
 

• Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES
  
• Conduct Medicaid System Assessments
  
• Help states plan for and execute SMC/OBC activities
  
• Help lead and provide expert level guidance on various projects
  
• Ensure planned results are achieved on time
  
• Work with clients, vendors, team members to establish and achieve project goals
  
• Address problems through risk management and contingency planning
  
• Plan, organize, execute, and monitor and control project activities
  
• Perform project assessments and report on project progress
  
• Facilitate meetings and present project information
  
• Identify, document, and/or escalate issues to appropriate levels
  

 
 

Required Skills/Experience

 
 

Qualifications

 
 

• Bachelor’s degree or equivalent university degree
  
• 5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative
  
• 4+ years experience performing performance metrics measurements and reporting to management and executive level staff.
  
• Demonstrated experience working with SMC/OBC
  
• Demonstrated written and verbal communications skills
  
• Ability to influence internal and external stakeholders
  
• Ability to lead/manage others in a matrixed environment
  
• Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools
  

 
 

#D-PCG

 
 

Compensation

 
 

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $110,000-$140,000

 
 

EEO Statement

 
 

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-implementation-administrator-55%25-travel-required-at-houston-isd-3432345888/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

POSITION TITLE: Medicaid Implementation Administrator (55% travel)

CONTRACT LENGTH:12M

GRADE: 27

 
 

Job Family – Finance & Accounting

 
 

JOB SUMMARY

Serves as the system application technical expert for client district customer support representatives and on-line billing staff. Trains other school districts on research, program development, implementation, and service provider licensure. Certifies Medicaid requirements for the district and each client district’s Medicaid revenue programs.

 
 

MAJOR DUTIES & RESPONSIBILITIES

1. Ensures medical billing and processing guidelines are followed. Analyzes day-to-day activities, solves and/or prioritize assignments. Trains client district administrators, clinicians, and teachers on the e-SHARS billing system and the Medicaid Reimbursement programs.

 
 

2. Trains various client districts on system and supports services to district employees to ensure maximum Medicaid reimbursement revenue and program compliance. Routinely travels throughout the state of Texas to provide annual Medicaid program policy/regulations and eSHARS system trainings. Provides new client program policy/system presentations.

 
 

3. Coordinates and supports the resolution of client district customer concerns/issues. Consults with school district administrators to establish monetary and regulatory compliant goals to achieve maximization for their districts Medicaid reimbursement.

 
 

4. Acquires and maintains current program policies and criteria to ensure infrastructure operations and performs district program audits.

 
 

5. Coordinates with the Technology team and outside vendors to analyze and resolve issues with the on-line system through system testing and quality assurance.

 
 

6. Prepares and files required reports to ensure client districts compliance with MAC quarterly claims, SHARS Cost Reports, Certification of Expended Funds (COEF) and MOE.

 
 

7. Performs other job-related duties as assigned.

 
 

EDUCATION: Bachelor’s Degree

 
 

WORK EXPERIENCE : 1-3 years

 
 

TYPE OF SKILL AND/OR REQUIRED LICENSING/CERTIFICATION

PeopleSoft preferred, Microsoft Office, SAP preferred, Chancery preferred

Office equipment (e.g., computer, copier)

 
 

LEADERSHIP RESPONSIBILITIES

No supervisory or direct people management responsibilities. May provide occasional work guidance, technical advice and training to staff.

 
 

WORK COMPLEXITY/INDEPENDENT JUDGMENT

Work involves the application of moderately complex procedures and tasks that are quite varied. Independent judgment is often required to select and apply the most appropriate of available resources. Ongoing supervision is provided on an “as needed” basis.

 
 

BUDGET AUTHORITY

Participates in a group plan and/or budget development.

 
 

PROBLEM SOLVING

Decisions are made on both routine and non-routine matters with some latitude, but are still subject to approval. Job is occasionally expected to recommend new solutions to problems and improve existing methods or generate new ideas.

 
 

IMPACT OF DECISIONS

Decisions have minor, small and possibly incremental impact on the department or facility. Errors are usually discovered in succeeding operations where most of the work is verified or checked and is normally confined to a single department or phase of the organizational activities resulting in brief inconvenience.

 
 

COMMUNICATION/INTERACTIONS

Information sharing – gives and receives information such as options, technical direction, instructions and reporting results. Interactions are with customers, own supervisor and coworkers in own and other departments.

 
 

CUSTOMER RELATIONSHIPS

Takes routine or required customer actions to meet customer needs. Responds promptly and accurately to customer complaints, inquiries and requests for information and coordinates appropriate follow-up. May handle escalated issues passed on from coworkers or subordinates.

 
 

WORKING/ENVIRONMENTAL CONDITIONS

Work is normally performed in a typical interior work environment which does not subject the employee to any hazardous or unpleasant elements. Ability to carry and/or lift up to 45 pounds or more.

 
 

To submit your application, please visit www.Houstonisd.org/Careers

Job ID: 122047

Clipped from: https://www.ziprecruiter.com/c/RSI/Job/Medicaid-Insurance-Follow-Up-Representative/-in-Columbia,SC?jid=42df7788155ac061&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

JOB SUMMARY:

Due to growth, RSi is hiring a Medicaid Insurance Follow-up Representative. This position will be responsible for reviewing data to ensure the validity of insurance information for claims processing, answering inquiries involving individual accounts, and researching denials and account issues to ensure accuracy for payment. If you are enthusiastic, sharp, and committed, we would love for you to join our team. This is a remote position and individuals can live anywhere in the U.S.

Job Responsibilities:
• Responsible for reviewing and processing Medicaid automated scrub results output.
• Follow up with insurance carriers to determine reason for claims’ denials and work to resolve claims for payment.
• Process claims, payments, adjustments, refunds, denials, and unpaid insurance balances.
• Assess and correct demographics, insurance, and financial information.
• Provide accurate account maintenance and documentation.
• Serve as a liaison with insurance companies, third party payors, and administrative personnel.
• Analyze EOBs and account documentation to identify, reconcile, and resolve patterns resulting in erroneous or no reimbursement.
• Review payor contracts and ensure accounts are resolved consistent with terms.
• Resolve insurance denials and file appeals with government and commercial carriers by:
    o Accurately and efficiently processing the account including transaction recording and other functions.
    o Staying up to date on contracts, regulations, procedures and other changes affecting the department.
    o Reporting unusual accounts, account problems, and workflow issues promptly to supervisor.
    o Demonstrating positive and professional communication skills.
• Perform other work duties as assigned.

Key Competencies:
• Results-Oriented
• Strong written and verbal communication skills
• Ability to handle and maintain confidential information
• Strong work ethic

Job Requirements:
• High School Diploma required 
• 2-4 years of Insurance Follow-up experience in a hospital or physician’s office setting is preferred 
• At least 1 year of general Epic navigational knowledge, with experience in billing within the Epic system is required 
• Thorough understanding of CPT, DRG, HCPC, Procedure and Revenue codes, modifiers and their effect on reimbursement 
• Experience with filing UB-04 and HCFA 1500 claim form required Physical Requirements: 
• Prolonged periods sitting at a desk and working on a computer. 
• Must be able to lift up to 15 pounds at times.

Clipped from: https://careers.browardhealth.org/job/17610067/specialist-medicaid-eligibility-ft-mon-fri-days-50493-bhc-fort-lauderdale-fl/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Broward Health is Broward County’s largest healthcare services provider and is one of the nation’s top public health systems. We are seeking a qualified professional to join our team.

Responsible for the daily coordination of activities within the Medicaid Eligibility Unit. Assist supervisor in day to day non-supervisory operations to ensure compliance with established policies, procedures and the application processing-time standards. Monitors, creates and analyzes applicable reports. Recommends and implements training for programs required by the department. Acts as a liaison between the Medicaid Eligibility team and the Medical Center Departments such as Patient Access, Case Management and Administration for confirming patient account status. Serves as a resource for staff.  Acts as a liaison between Medicaid Eligibility team and I.S. department for troubleshooting computer problems.  Recommends and organizes departmental changes in technological needs.

High school graduate or equivalent. Four years of related experience. Maintains systems with accurate status to ensure timely processing.
Strong computer skills, analytical skills, and communication skills both written and verbal. Bilingual English/Creole preferred.

 
 

Must show proficiency in performing all departmental tasks with minimal supervision. Proficient in Microsoft Applications. Must show knowledge of Medicaid Eligibility programs.

Thank you for your interest in Broward Health. Broward Health is an EO/AA procurer of goods/services, M/F/D/V.