Category: Curator- Job Hunter

 
 

Job Details

MEDICAID PROGRAM MANAGER 1–A

This listing closes on 3/12/2021 at 11:59 PM Central Time (US & Canada).

Salary $26.71 – $52.56 Hourly $4,630.00 – $9,110.00 Monthly

$4,630.00 – $9,110.00 Monthly

Location Baton Rouge, LA

Baton Rouge, LA

Job Type

Classified

Department

LDH-Medical Vendor Administration

Job Number

MVA/SAG/1980

Closing date and time

3/12/2021 at 11:59 PM Central Time (US & Canada)

• Description
• Benefits

Supplemental Information

Job Number: MVA/SAG/1980
 
 This position is located within the Louisiana Department of Health l Medical Vendor Administration l Medicaid Enterprise Systems (MES)  l  EBR Parish.
 
 Cost Center: 0305-7103
 Position Number(s): 50382733
 
This vacancy is being announced as a Classified position and may be filled either as a Probationary Appointment, Job Appointment or Promotional Appointment.  

(Job Appointments are Temporary Appointments up to 48 months)

 
****REVIEW YOUR APPLICATION TO MAKE SURE IT IS CURRENT. Failure to provide your qualifying work experience may result in your application not being considered.****
 
 
There is no guarantee that everyone who applies to this posting will be interview.  The hiring supervisor/manager has 90 days from the closing date of the announcement to make a hiring decision.  Specific information about this job will be provided to you in the interview process, should you be selected.

No Civil Service test score is required in order to be considered for this vacancy.  
 
To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
 
*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*
 
For further information about this vacancy contact:
Sanaretha Gray @ Sanaretha.Gray@la.gov    
LDH/HUMAN RESOURCES
P.O. BOX 4818 BATON ROUGE, LA 70821
225 342-6477

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus four years of professional experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.

 
 

SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.

Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:

A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.

30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

 
 

Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; public relations; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.

 
 

A master’s degree in the above fields will substitute for one year of the required experience.

 
 

A Juris Doctorate will substitute for one year of the required experience.

 
 

Graduate training with less than a Ph.D. will substitute for a maximum of one year of the required experience.

 
 

A Ph.D. in the above fields will substitute for two years of the required experience.

 
 

Advanced degrees will substitute for a maximum of two years of the required experience.

 
 

NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

Job Concepts

Function of Work:
To administer small and less complex statewide Medicaid program(s).

Level of Work:
Program Manager.

Supervision Received:
Broad from a higher-level manager/administrator.

Supervision Exercised:
May provide functional supervision in accordance with the Civil Service Allocation Criteria Memo.

Location of Work:
Department of Health and Hospitals.

Job Distinctions:
Differs from Medicaid Program Monitor by responsibility for administering small and less complex statewide program(s).

Differs from Medicaid Program Manager 1-B by the absence of supervisory responsibility.

Differs from Medicaid Program Manager 2 by the absence of responsibility for administering medium size and moderately complex statewide program(s).

Examples of Work

Supervises the auditing of eligibility enrollment of all Medicaid programs statewide.

Reviews work of eligibility review staff for quality assurance.

Plans, coordinates, and controls small or less complex statewide program(s).

Plans, develops, implements and monitors comprehensive Medicaid program policies.

Conducts and directs studies/special projects pertaining to the programs assigned.

Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.

Reviews and analyzes complex data and system reports to ensure compliance with program regulations.

Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.

Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.

Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.

Identifies, verifies and analyzes the various revenue sources for the program(s). Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.

Benefits

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to “make a difference” through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits and have access to a great professional development program.

Flexible Working Arrangements – The flexibility of our system allows agencies to implement flexible working arrangements through the use of alternative work schedules, telecommuting and other flexibilities. These arrangements vary between hiring agencies.

Professional Development – The Comprehensive Public Training Program (CPTP) is the state-funded training program for state employees. Through CPTP, agencies are offered management development and supervisory training, and general application classes on topics as diverse as writing skills and computer software usage.

Insurance Coverage – Employees can choose one of several health insurance programs ranging from an HMO to the State’s own Group Benefits Insurance program. The State of Louisiana pays a portion of the cost for group health and life insurance. Dental and vision coverage are also available. More information can be found at www.groupbenefits.org.

Deferred Compensation – As a supplemental retirement savings plan for employees, the State offers a Deferred Compensation Plan for tax deferred savings.

Holidays and Leave – State employees receive the following paid holidays each year: New Year’s Day, Martin Luther King, Jr. Day, Mardi Gras, Good Friday, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and Christmas Day. Additional holidays may be proclaimed by the Governor. State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works).  These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): Louisiana State Employees Retirement System (www.lasersonline.org), Teacher’s Retirement System of Louisiana (www.trsl.org), Louisiana School Employees’ Retirement System (www.lsers.net), among others. LASERS has provided this video to give you more detailed information about their system.

Agency State of Louisiana Phone (866) 783-5462 Website http://agency.governmentjobs.com/louisiana/default.cfm

Address For agency contact information, please refer to
the supplemental information above.
Louisiana State Civil Service, Louisiana, 70802

Clipped from: https://www.governmentjobs.com/jobs/2997918-0/medicaid-program-manager-1-a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Manages entire process of the development and submission of complex, large-scale Medicaid proposals from RFP release to proposal delivery and through any additional protest periods, delegating to and coordinating with Proposal Deputy, as applicable. Responsible for ensuring Molina capabilities and strategic, forward-thinking vision is captured within the response by working with strategic leaders and coordinating the development of strategic direction. Works enterprise-wide to establish excellent working relationships with subject matter experts and coordinates with large-scale teams to ensure proposal success.

Manages and provides development, compilation, editing, and submission of compliant, client-focused, and technically accurate Medicaid proposals. Ensures 100% compliance with proposal requirements; 100% of proposals must be submitted by client-provided deadline. Establishes and maintains a compliant work plan, a proposal schedule, all other proposal documentation, and provides overall RFP analysis. Supports RFP, RFA, and RFI response projects, while contributing to procurement opportunities and development of strategies and content that enhance response quality.

Must have demonstrated experience managing very large and complex bids and experience managing multiple proposals at a time is a plus. Willingness to work extended hours and assist team members in meeting deadlines as necessary. Proofreading skills, acute attention to detail, and ability to handle demanding, deadline-driven situations. Must be very dependable and possess exceptional customer service skills. Serves as a mentor to proposal managers and assists other Directors of Proposal Management, as required, serving as a proxy in his/her absence, as necessary.

Knowledge/Skills/Abilities

* Analyzes RFPs and applies appropriate proposal process and procedures
* Allocates resources, and monitors requirements, deadlines, and assembly/submission
* Researches, analyzes, and coordinates overall strategic vision for proposal compliance and successful messaging

o Defines style conventions based on proposal team standards and the RFP

o Establishes and maintains all proposal documentation (schedule, work plan, etc.)

o Gathers and coordinates discussion and delivery of RFP questions

o Plans and leads meetings (e.g., kick-offs, status meetings, etc.) and all color reviews

* Ensures proposal compliance with RFP and the completion of all required forms
* Assists in the development of executive summaries; writes proposal sections as needed
* Oversees the proposal’s online workspace (SharePoint)
* Coordinates with-and supports-graphics and production efforts
* Reviews and edits all proposal sections, providing ultimate sign-off
* Reviews final document and leads white glove and book check
* Ensures on time production and communicates delivery plan
* May have direct reports
* Other duties as assigned

Job Qualifications

Required Education

Graduate Degree or equivalent combination of education and experience

Required Experience

7-9 years of proposal management or applicable experience

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

10 years of proposal management or applicable experience

Preferred License, Certification, Association

Project Manager or Proposal Management certification

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

 
 

Clipped from: https://www.zippia.com/long-beach-ca-jobs/director-dlp/?eff5ed2c7968aeff9273089956b56b3259fc6fb4&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Medicaid Billing Specialist

Ajilon is assisting with a search for a Medicaid Billing Specialist for a Client in Kansas City, MO. Your primary job duties will be responsible for billing and invoicing for all Medicaid programs as well as monthly, quarterly and annual reports, audits, tracking and drawdowns. Our ideal candidate would have exposure to Medicaid, at least 2 years of medical billing experience and have strong attention to detail and ability to make an appeal if necessary. This role will be on-site following social distancing guidelines with pay starting at $18ph and going up with experience. There are TONS of GROWTH opportunities in this role with potential to manage a team in 1-2 years. Read below for additional details!

RESPONSIBILITIES:

• Responsible for billing, reviewing, and submitting files for the following programs and services: Consumer Directed Services, In Home, Money Follows the Person, HCBS Program, Employment Program, Transportation, and other organizational billings.
• Responsible for importing of the 835 files into the billing software; reconciling billed vs paid claims including Medicaid remittances; resubmitting corrected claims and identifying uncollectible claims.
• Provide staff information regarding billing discrepancies, ineligible claims, and Medicaid eligibility.
• Ensure organization is current and complies with federal and local healthcare regulations, policies, and procedures; disseminates information to staff as needed.
• Completes Quarterly and Annual Reporting for: Missouri Vocational Rehabilitation, Federal Grant, CDS Financials, Home Health Statistical Report, IL Grant application and other reports as needed.
• Responsible for Home Health month-end close; updating HCBS accounts receivable analysis; and Transportation Department analysis
• Responsible for utilization calculations/tracking for Home Health, In-Home & CDS.
• Responsible for Monthly tracking for MFP reimbursable & Employment Invoices.
• Responsible for the drawdown on Federal Grants according to CFO’s instructions.
• Completes various audit reports as scheduled.
• Assists accounting department with special projects as assigned.

QUALIFICATIONS:

• High school diploma, GED or equivalent work experience
• At least 2 years medical billing experience with exposure to Medicaid Billing
• Skilled in the use of computers and the Microsoft Office and excel applications.
• Prior experience with eMOMED and any Medicaid billing software
• Strong organizational skills.
• Great customer and communication skills.
• Works under the pressure of deadlines.
• Ability to follow process procedures.
• Ability to work well with others in a team environment.
• Great attention to detail!
• Strong organizational skills
• Ability to learn quickly

Do you have experience with medical office administration or billing and are looking for an immediate opening? If so, apply now!! Go to www.ajilon.com and submit your resume for consideration.

 
 

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please click here.

The Company will consider qualified applicants with arrest and conviction records
 

Clipped from: https://www.ajilon.com/jobs/medicaid-billing-specialist/?ID=US_EN_7_849131_2821387&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose: Reporting to the Senior Manager of Analytics and in support of the Director of Medicaid ACO, the Senior Analyst serves as the key analytic resource to meet the information, reporting, and analytic needs of Steward Health Care Network (SHCN)’s Medicaid Accountable Care Organization.

• Conducts sophisticated business analyses to support Medicaid ACO program development and ongoing operations, grounded in deep expertise and functionality with both internal and publicly available Medicaid-related health care data sources
• Draft memos and bulletins that summarize key conclusions and findings of impact analyses to inform Steward’s leadership teams
• Analyze and recommend opportunities and financial impacts of strategic partnerships, new Medicaid programs, and key Medicaid ACO related initiatives
• Deliver accurate and on-time deliverables, including reports, cost estimates, models and ad-hoc analyses
• Develop and program comprehensive, timely, and accurate analyses, reports, and presentations on utilization, leakage, risk performance, care management, and quality metrics to support the operation of SHCN’s Medicaid ACO;
• Work with business and operational leaders to identify TME opportunities and quantify ROI for related programs
• Coordinate with Steward’s internal data, analytics, and information technology teams to manage data and reporting related to Medicaid programs
• Identify opportunities to improve and enhance the analysis and information provided to SHCN leadership, participating network providers, and community partner organizations
• Work with analysts and analytic tool vendors to improve standard report design
• Support ad hoc analytic requests, providing accurate and timely data, analysis and insightful interpretations
• Performs other duties as requested

Education / Experience / Other Requirements

Education:

• Bachelor’s degree required, Master’s preferred

Years of Experience:

• 3-5 years of relevant experience in healthcare, analytics, or informatics

Specialized Knowledge:

• Possess strong analytic and technical skills plus an ability to translate complicated data into useable information;
• Ability to work on multiple projects simultaneously, deliver work products on deadline, and respond to new requests with fast turn-around, as needed
• Possess strong skills in SQL, Excel, Access and PowerPoint
• Organizational and project management skills to manage projects effectively;
• Demonstrated knowledge of relationships between health plans and providers, including detailed understanding of health plan data and familiarity with Medicaid and other public programs;
• Possess an in-depth understanding of claims data, including ICD-9 & CPT codes, DRGs, health status and risk adjusters;
• Excellent verbal and written communication skills, including the ability to graphically present complex data; outstanding interpersonal skills; and ability to relate positively with individuals at all levels of the organization
• Creative, flexible, and self-motivated with sound judgment; ability to plan and implement;
• Commitment to service excellence

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

Clipped from: https://stewardwestjobs.steward.org/senior-analyst-medicaid-aco/job/15662453?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position Purpose:

Maintain internal computer system’s Medicaid managed care membership records related to the qualifications a person or dependent must meet for coverage under the State contract or agreement through thorough research and/or collaboration with the agency contracted by the state to provide information to the Company.

 

• Provide timely, efficient support for the eligibility load process while coordinating with Corporate IS department to resolve issues that arise during the process.
   
• Provider research to correct errors in membership and PCP (Primary Care Physician) data input within the AMISYS system.
   
• Complete monthly reconciliation process of remittance files by resolving discrepancies in report.
   
• Generate internal ad-hoc reports and analysis as needed.
   

Education/Experience:

High school diploma or equivalent. 2+ years of experience in member enrollment, membership eligibility records, member services and data analysis. Knowledge of Medicaid managed care programs and practices, preferably for the assigned State. Experience with the Amisys system preferred.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

 
 

Clipped from: https://jobs.centene.com/us/en/job/1217049/Eligibility-Specialist-I?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Enrollment Medicaid Specialists provides Healthfirst’ s Medicare Advantage Plan (MAP), Senior Health Partners’ (SHP) Managed Long|Term Care (MLTCP), FIDA and Nursing Home members and families with assessment and interventions related to enrollment processing of qualified, eligible candidates for enrollment and obtaining and retaining of financial entitlements for which they are eligible. This enables members to maintain the highest level of independence both at home and within their communities.
Frequently communicates moderately complex information and interacts through electronic documentation tools. This is a paperless work environment requiring daily hands|on administration of multiple electronic Patient Health Information (PHI) databases and security requirement tools such as encryption. These systems include but are not limited to CCMS (CareEnhance Clinical Management Software), Sunguard MACESS Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word, Excel and Outlook). Ours is a paperless work environment requiring daily hands|on administration of multiple proprietary and packaged electronic databases including security requirement tools such as encryption. These systems include but are not limited to CCMS (CareEnhance Clinical Management Software), Sunguard MACESS Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (VPN), creating pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word, Excel and Outlook).

Conducts individual pre-enrollment screening:

Meets with individuals who may qualify for enrollment in Senior Health Partners or Montefiore MSO throughout the 5 boroughs, Westchester and Nassau County. Explains the program features, benefits and commitments, including explanation of the Member Handbook.

-Identifies obstacles and opportunities for enrollment:

Obtains feedback from referral sources and prospective enrollees.

Stimulates word-of-mouth referrals from participants, prospects and their families.

Assists with orientation of new Enrollment Specialists at Senior Health Partners so they understand the model, support enrollment growth and are able to answer routine questions about the program.

-Participates in the care team for continuous performance improvement:

Facilitates problem-solving for performance improvement.

Contributes to the team’s efforts to every enrollee with respect, courtesy and fairness in a way that provides superior customer service.

Complete Medicaid applications for New Enrollees and Renewals as needed.

Contact member or primary caregiver in person, by phone or letter to arrange an interview to assess Medicaid eligibility.

Complete Medicaid application in a timely, organized fashion and assists participant or primary caregiver in the completion of the Medicaid application.

Facilitate compilation of all required documents. Call, write or in person contacts landlords, employers, bankers, insurance companies, etc. to obtain required documents.

Submit documentation to Human Resource Administration (HRA) within specified time-frame to assure Medicaid coverage for participant.

Track the Medicaid status for all new enrollees.

Has full and complete access to patient records and reports as well as to personal/financial profiles and documents, calling for the utmost integrity at all times.

Assist Intake and Care Teams in confirming Medicaid eligibility upon referral by Enrollment or Care Teams.

Researches Medicaid through www.eMEDNY.org and ePACES.

Consult with HRA Medicaid staff as needed and report to supervisor any need for HRA consultation.

Monitor Medicaid re-certification time frames for each active Medicaid member.

Contact members two months prior to MA expiration date.

Ensure completion of re-certification application.

Maintain records on every member to show coverage status and timing of re-certification in CCMS Management Information System (MIS).

Document status of Medicaid and entitlement coverage in designated CCMS Management Information System (MIS).

Prepare/submit monthly reports.

Serve as a resource to Care Management Teams for Medicaid and other Medicare savings Programs.

Keep up-to-date on Medicaid and other program issues as well as on changes in Medicaid/Medicare/HMO laws and shares information with other Social Work and Care Team members as appropriate.

Participate in relevant entitlement training/meetings.

Serve as the liaison between all parties and acts as Member advocate maximizing the participant’s support network and obtaining needed services.

Maintain contact between participant/primary support, business office, social worker and enrollment specialist to keep parties updated regarding progress of MA and other entitlement applications.

Maintain contact between participant/primary support and Medicaid staff of Human Resource Administration as needed.

Engage in mastering the Divisions impact on HF/SHP and its Members.

Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects.

Maintain the highest level of integrity, courtesy, and respect while interacting with clients, employees and business contacts.

Handle other duties as assigned.

1 year of job specific industry experience in Long-Term (LT) or Managed Long-Term Plan (MLTCP).

– Associates degree or 60 college credits and 1 year of work-related and job specific experience.

-Technical skills in e-faxing, electronic archiving or encryption.

-Knowledge of current community health practices for the frail adult population and/or cognitively impaired seniors including the values offered with integrated care.

-Experienced in one or more of the following additional areas: health insurance, home care environment, acute or sub-acute.

-Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), and Federal Employee Program (FEP).

-Experience training or coaching junior staff in daily department operational procedures and product knowledge.

-Valid Driver’s License

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

 
 

Clipped from: https://www.themuse.com/jobs/healthfirst/enroll-medicaid-specbilingual-spanish?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position Description:

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the companys growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Read more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.

Mathematica is searching for a seasoned professional with experience leading research focused on Medicaid policy and programs or developing analytic approaches to guide policy development and implementation at either the state or federal level. The successful candidate will join our Health division to play leadership roles in engagements for the Center for Medicaid and CHIP Services, Medicaid and CHIP Payment Access Commission, state Medicaid agencies, and other clients.

In particular, we are looking for individuals who can support current and emerging work across several areas related to monitoring and improving Medicaid and CHIP programs such as:

• Evaluating and delivering technical assistance on delivery system reform, including value-based care, alternative provider payments and care delivery models, and supplemental payment streams including UPL and DSH
• Providing subject matter expertise on Medicaid managed care programs including MLTSS, innovations in social determinants of health, and/or quality improvement in Medicaid programs including behavioral health and substance use disorder treatment and HCBS.
• Developing, testing, and supporting the collection of measures of delivery and quality of services for beneficiaries; and
• Designing data analytics to monitor and evaluate outcomes of innovative programs and policies.

Candidates do not need to have experience in all of these areas but should be expert in at least one.

The successful candidate will join our group of over 500 health policy professionals, including staff with degrees in data analytics, public health, public policy, economics, behavioral or social sciences, and other relevant disciplines. We offer our employees a stimulating team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership.

Duties of the position:

• Direct or play key leadership roles in multidisciplinary teams to conduct research and technical assistance projects on topics related to state and federal Medicaid and CHIP policy and data systems, and oversee all aspects of high quality project delivery
• Engage with state and federal clients to understand the challenges they face and work collaboratively with them to develop innovative solutions
• Apply rigorous analytic thinking to the collection and interpretation of quantitative and qualitative data, including analysis of Medicaid and CHIP administrative data and site visits or telephone interviews with state and federal officials
• Direct business development efforts and lead proposals for new projects
• Author project reports, memos, technical assistance tools, issue briefs, and webinar presentations and represent Mathematica to policy and professional audiences
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid and CHIP area, including active mentorship

 
 

Position Requirements:

Position Requirements:

• At least 8 years of experience working in health research, data analytics, or health policy with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level
• Bachelors, Masters or doctoral degree or equivalent experience in data analytics, public policy, economics, behavioral or social sciences, public health, or other relevant disciplines
• Expertise in quantitative and/or qualitative methods and a broad understanding of health policy issues
• Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakers
• Demonstrated ability to lead major engagements and coordinate the work of multidisciplinary teams, including collaborations with technology teams building solutions in service to policy needs
• Strong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines

To apply, please submit a cover letter, resume, writing sample, and salary expectations at the time of your application.

You will work in a multidisciplinary setting that includes staff with degrees in statistics, business, public policy, economics, psychology, education, sociology, demography, and related fields. We take pride in our employees and in their commitment to excellence. We encourage staff to collaborate in developing creative solutions to difficult problems. This collegial spirit has helped us earn our reputation for innovative and high-quality work. As a winner of the “Excellence in Diversity Award,” we know that building an inclusive culture based on the diverse strengths of employees from different backgrounds is key to our success.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

Available Locations: Princeton, NJ; Washington, DC; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Oakland, CA; Chicago, IL

This position offers an anticipated annual base salary range of $120,000 to $180,000. This position is eligible for an annual bonus, based on company and individual performance.

 
 

Clipped from: https://www.glassdoor.com/job-listing/senior-medicaid-lead-mathematica-policy-research-JV_IC1134560_KO0,20_KE21,48.htm?jl=3704589776&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

About AbbVie
AbbVie’s mission is to discover and deliver innovative medicines that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people’s lives across several key therapeutic areas: immunology, oncology, neuroscience, eye care, virology, women’s health and gastroenterology, in addition to products and services across its Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com . Follow @abbvie on Twitter , Facebook , Instagram , YouTube and LinkedIn .


I. POSITION SUMMARY:


Responsible for the administration and analysis of State Medicaid contracts including reviewing and validating submissions, processing and paying rebates, and analyzing quarterly utilization and rebate trends and variances. Manages responsibilities in accordance with various state & federal regulations including but not limited to: Section 1927 of the Social Security Act, the Omnibus Budget Reconciliation Act of 1990 and 1993, Section 602 of the Veterans Healthcare Act, and Sarbanes Oxley as well as internal policies and procedures.


II. PRIMARY JOB RESPONSIBILITIES:

 
 

1. CONTRACT ADMINISTRATION/PROCESS REBATES: Review and analyze all contract fields and evaluate contract language to uphold integrity of the rebate processing system. Manage contract changes such as adding/deleting products. Review and analyze pricing in the contract systems; ensure accurate reimbursement in a timely manner; maintain proper contract files; monitor contract expiration report. Process Medicaid rebate Claims within the systems Medicaid Module for Federal Statutory Programs, State Supplemental, and State Pharmaceutical Assistance Programs (SPAPs). Resolve open disputes with states. Work closely with State personnel, internal customers, and finance and rebate teams. Maintain good customer relations.

 
 

 
 

 
 

1. SYSTEM MAINTENANCE: Load/maintain all products, pricing and contract information in the Revitas Medicaid Module; ensure proper set-up, coverage, calculation and reimbursement of all programs & products. Perform system preparation for each quarterly rebate cycle including but not limited to, RPU calculations, new product baseline data, T-Bill rates, CPI-U indexes, calculation methods, etc. Work with internal & external IT support teams on system issues, upgrades and patches. Review, analyze and resolve price discrepancies with CMS and the states; follow-up and correct all issues related to processing claims or system issues.

 
 

 
 

 
 

 
 

1. REPORTS & ANALYSIS: Compile necessary reports needed to support pricing disclosures; document explanations in file. Compile & distribute quarterly sales, trend, and rebate reports to internal and external customers. Use internal systems to compile data necessary to research specific price issues related to internal self-audit or government-initiated audits.

 
 

III. ADDITIONAL JOB RESPONSIBILITIES:

 
 

 
 

 
 

 
 

• STANDARD OPERATING PROCEDURES: Update SOP’s as changes in law, business, systems, or processes dictate. Ensure proper compliance with Sarbanes Oxley controls; submit reports necessary to audit tests.

 
 

 
 

 
 

• FILE MAINTENANCE/DOCUMENTATION: Compile and maintain files for quarterly submissions, contracts, etc.

 
Qualifications

IV. POSITION QUALIFICATIONS:

Education: BA/BS, or equivalent experience required

Experience: 2+ years business experience, preferably with a concentration in contracting, and Medicaid related activities or financial analysis

Knowledge, Skills, and Abilities

   
 

1. Strong analytical, problem-solving and organizational skills
2. Proficiency in Microsoft Excel
3. Excellent analytical and organizational skills
4. Ability to manage multiple tasks, priorities and timelines
5. A self-starter who can work independently
6. Functional knowledge of Revitas/Model N and Medicaid systems preferred

 
V. PHYSICAL REQUIREMENTS:

While performing the duties of this job, the employee is required to:

  
 

1. Communicate effectively with internal and external individuals
2. Use computer, phone and other related business machines
3. Sit for prolonged periods of time
4. Travel to/Attend meetings off company premises

 
Significant Work Activities
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)
Travel
No
Job Type
Experienced
Schedule
Full-time
Job Level Code
IC
Equal Employment Opportunity
At AbbVie, we value bringing together individuals from diverse backgrounds to develop new and innovative solutions for patients. As an equal opportunity employer we do not discriminate on the basis of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information gender identity or expression, sexual orientation, marital status, protected veteran status, or any other legally protected characteristic.

 
 

 Clipped from: https://www.biospace.com/job/2252743/medicaid-analyst/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

HEALTHCARE ACCESS MARYLAND INC

 
 

 Baltimore, MD Full Time

Job Posting for Medicaid Specialist at HEALTHCARE ACCESS MARYLAND INC

Job Details

Level:    Entry

Job Location:    The Match Program – Baltimore, MD

Position Type:    Full Time

Education Level:    2 Year Degree

Salary Range:    Undisclosed

Job Shift:    Day

Description

The Medicaid Specialist organizes and completes required forms for Medical Assistance enrollment and redeterminations for children committed to the Baltimore City Department of Social Services foster care.

 
 

The primary responsibilities for this position are:

• Utilize the MMIS and CARES systems to verify coverage of current foster care children
• Troubleshoot problems with Medical Assistance enrollment including identifying reasons for MA inactivation or problems completing enrollment
• Enter medical assistance case information required for BCDSS reporting into MATCH program database according to program practice guidelines
• Coordinate and track enrollment in Medical Assistance enrollment by working with FIA-Central MA Foster Care Unit, and DHMH.
• Track and distribute MA cards, MCO cards, and Dental cards to caregivers
• Distribute copies of MA cards, MCO cards, and Dental cards to BCDSS permanency staff and upload in MATCH database.
• Prepare monthly report for Dental card requests and organize distribution of dental cards in the absence of the Medicaid Specialist Lead
• Provide monthly MA department numbers to the Medicaid Supervisor
• Provide other administrative support for MATCH as needed

Qualifications

 
 

Requirements & Experience:

• Bachelor’s Degree preferred, Some College required
• Candidate must have a minimum of 2 years administrative experience
• Experience in the health field preferred
• Knowledge of Medicaid preferred
• Self-motivated individual to assist with general office duties
• Proven ability to meet deadlines
• Strong customer service skills
• Ability to thrive in a TEAM environment
• Good planning and organization skills
• Well developed interpersonal & communication skills
• Professional appearance and demeanor
• Computer literate specifically MS Word, Excel, Access, and Google mail

 
 

Physical Requirements:

• Ambulate 3 blocks or more
• Key data
• Sit for extended periods
• Lift at least 15 lbs.

 
 

Clipped from: https://www.salary.com/job/healthcare-access-maryland-inc/medicaid-specialist/421925a0-a295-42da-ab7a-7bc19eba18ea?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Details

Auditor IV – Medicaid Provider Fraud

This listing closes on 3/8/2021 at 5:00 PM Eastern Time (US & Canada).

Salary

$40,759.00 – $75,413.00 Annually

Location Richland County, SC

Richland County, SC

Job Type

FTE – Full-Time

Agency

Attorney General’s Office

Job Number

110574

Closing date and time

3/8/2021 at 5:00 PM Eastern Time (US & Canada)

Agency Specific Application Procedures:

Applications accepted via NeoGov

Class Code:

AD12

Position Number:

60009572

Normal Work Schedule:

Monday – Friday (8:30 – 5:00)

Pay Band

Band 6

Opening Date

02/25/2021

EEO Statement

Equal Opportunity Employer

• Description
• Benefits
• Questions

Job Responsibilities

Unique analyst position functions as a member of multi-disciplined team, consisting of attorneys, investigators, and administrative support, in investigating alleged fraud conducted by Medicaid providers. Receives hotline calls and conducts initial review of referrals from various sources, interprets information from an investigative perspective utlizing healthcare billing data and other resources available. Compiles information into a report format while consulting with other MFCU staff within a team setting to assist with decisions relating to case openings, closures, or outside referrals. Position will require working with investigators and staff attorneys in becoming familiar with common provider fraud schemes to aide in the intake process.  Will also participate in investigations into vulnerable adults being financially exploited. Will develop an understanding and knowledge of the laws, regulations and procedures that govern the SC Medicaid program. Participates and offers strategy in investigative team discussions. Extracts billing data from South Carolina Medicaid and prepares specific analyses. Utilizes data analysis and other resources to identify and communicate trends, patterns, or schemes. Examines financial records and Medicaid billing records to trace the source of fraud. Makes supported assessment of fraud damages and prepares spreadsheets to identify discrepancies. Presents data highlights, with insights, to both internal and external stakeholders. Assists external State and Federal agencies with data analysis. Collects, evaluates, and analyzes data and other evidence. Prepares exhibits for use in trial. Provides courtroom testimony. Collaborates with other states in working on cases with national impact.   Assists Unit Director with financial reporting and budget documents; general unit performance tracking, statistics and reporting; and other required duties as requested.  Participates in trainings and networking/outreach events.

An employee of the Office of the Attorney General will receive an attractive benefits package, opportunities for further training, and the chance to advocate for South Carolina’s future. 

Who We Are:
The Office of the Attorney General is a historic state agency focused on upholding the rule of law and protecting the citizens of South Carolina. From its founding in 1698 to present day, the Office of the Attorney General has played an integral part in shaping the history of South Carolina. We are not just looking for someone to be a part of South Carolina’s history; we are seeking someone who will be an advocate for South Carolina’s future. Employees can expect to work in a unified environment on challenging and meaningful work. All staff receives an attractive state government benefits package and opportunities for further training and growth opportunities. Join the Office of the Attorney General in protecting the Constitution and serving the citizens of South Carolina.

Minimum and Additional Requirements

Bachelor’s degree and 3 years professional experience in accounting, auditing, finance, insurance, statistical or data analysis. Successful completion of required skills assessment during the interview process.

Preferred Qualifications

Required:
 

• Proficiency in Excel and Access
• Ability to communicate technical information to non-technical audiences, both orally and in writing/visuals
• Ability to identify and recognize data patterns and quantify potential issues
• Experience in analyzing financial documents
• Ability to develop investigative strategies
• Ability to work on a team
• Self-motivated
• Ability to foster a collegial work environment
• Strong organizational skills

 
Preferred:
 

• Experience conducting a white collar and/or healthcare fraud investigations or administrative reviews
• Knowledge of healthcare terminology and coding systems such as ICD 9/10, CPT, and HCPCs
• Certified Fraud Examiner
• Familiarity with Truven, SAS, MMIS, bank scan, or other similar software software
• Prior law enforcement and/or healthcare administration experience. 
• Knowledge of statistical sampling techniques

Additional Comments

DRUG SCREENING, CREDIT CHECK, DELINQUENT TAX CHECK AND SLED BACKGROUND CHECKS REQUIRED.
THIS OFFICE IS AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER.
EEOP Utilization Report Available Upon Request
 

Benefits for State Employees

 
The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.
 
Insurance Benefits
Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.
 
Retirement Benefits
State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.
 
Workplace Benefits
State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.
 
Note: The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.
 

01

Do you have a Bachelor’s degree and three years professional experience in accounting, auditing, finance, insurance, statistical or data analysis.

• Yes
• No

02

A resume may be attached, but not substituted for completing the work history, education and reference sections of the employment application. Incomplete applications will not be considered. Is your application complete?

• Yes
• No

* Required Question

Agency State of South Carolina Phone 803-734-3970

Agency Attorney General’s Office Address 1000 Assembly Street, Dennis Bldg.


Columbia, South Carolina, 29201

Apply

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