Category: Curator- Job Hunter

 
 

Job Description

Job Summary
Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan’s member and enrollment records, employer’s monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Work Location – Remote, within the United States of America

Knowledge/Skills/Abilities

• Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions.
• Monitors and enforces compliance with company-wide reconciliation processes.
• Ensures that delivery of enrollment / premium related data is accurate for defined region.
• Subject matter expert for projects and / or new business related to areas of oversight.
• Oversees maintenance of policies and standard operating procedures..


Required Education
Graduate Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Experience

10+ years


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://molina-healthcare.talentify.io/job/director-medicaid-enrollment-remote-long-bch-california-molina-healthcare-2016368?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description/Job Summary

 
 

Sellers Dorsey is a leading healthcare consulting firm specializing in Medicaid financing, policy and operations. Our National Medicaid Financing Practice works with clients such as states, counties, health systems, safety net hospitals, academic medical centers, physicians, nursing facilities and medical schools navigate the opportunities to strengthen their Medicaid business through the conception, creation and implementation of programs designed to increase Medicaid reimbursement and leverage their unique capacities to deliver on the quality and value propositions growing in Medicaid. Our teams work together to ensure that technical, policy and political solutions are created to ensure successful results for our clients, particularly in the area of Medicaid financing.

 
 

The Associate Director will assist the Sellers Dorsey team by leveraging deep knowledge of policy and/or financial expertise in areas such as Medicaid financing and revenue maximization, provider reimbursement (physician, hospital, other), state and federal Medicaid reimbursement policy, healthcare taxes, intergovernmental transfers, and navigating the shift to value-based payment and/or provider operations. They are responsible for policy guidance, development of financial estimates and understanding state and federal reimbursement systems.

 
 

The Associate Director is a key member of the client servicing team, helping implement and manage new programs for clients and ensuring a high level of satisfaction. In addition to client servicing, the Associate Director assists the sales team by identifying new business opportunities, expanding existing engagements and participating in sales activities, including attending prospective client meetings.

 
 

Responsibilities/Duties

 
 

General Responsibilities and Expectations

 
 

• Associate Directors are expected to account for hours on a monthly basis. They will be assigned to client project teams and will also spend time on sales and marketing and administrative activities, as needed. Associate Directors are expected to review periodic activity reports and work with their supervisors to develop strategies to ensure targets are met.
  
• Sellers Dorsey Associate Directors are expected to travel as needed to meet the needs of client servicing, marketing, and business development. National travel up to 50% may be required. Associate Directors understand that work may require periodic availability on weekends and nights.
  
• Associate Directors are responsible for keeping current on the changing federal regulatory environment, learning state specific regulations to support assigned projects, and staying current on industry trends.
  

 
 

Consulting Services

 
 

• Depending upon specific areas of expertise, assume significant levels of responsibility on a diverse range of projects and project tasks; develop consulting expertise that can be replicated in future projects.
  
• Manage all technical aspects of Medicaid financing initiatives.
  
• Perform assigned and agreed upon project tasks maintaining client satisfaction; takes ownership of work and assists in the development of “client-ready” deliverables.
  
• Deliver subject matter expertise and consulting services for multiple clients/projects, clients and engagements; manage assigned primary research and/or solution development; assist with proposal development, project plan development, data analysis and modeling, presentation development, and delivery of client presentations.
  
• May serve as a key client contact to respond to questions, provide required communications and be responsible for a successful client engagement
  

 
 

Business Development

 
 

• Use personal industry knowledge, connections, business expertise, public policy awareness and political insight to identify leads that could result in profitable revenue growth for the Firm.
  
• Actively provide proposal development assistance including proposal drafting, editing, scope development, and related duties and participate in sales meetings, as necessary.
  
• Actively seek to identify new business opportunities for the Firm within assigned clients to help maximize long term benefits and relationship between the client and Sellers Dorsey.
  
• In coordination with the marketing team, produce and review content for selected internal and external marketing tools, such as Firm newsletters, conference presentations, website content, and marketing webinars, to highlight the Firm’s capabilities, subject matter expertise and successes.
  

 
 

Knowledge Management

 
 

• Leverage policy and/or healthcare solution expertise to help the Firm develop, document and communicate new solutions.
  

 
 

Required Qualifications

 
 

Education and Work Experience

 
 

• Bachelor’s degree and 10 or more combined years in Medicaid, provider reimbursement and/or in the healthcare consulting industries.
  
• Understanding of Medicaid financing and payments.
  
• Experience working with healthcare data such as claims sets, cost reports, etc.
  
• Experience in Medicaid agency, CMS or healthcare providers preferred.
  
• Experience with value-based payment arrangements preferred.
  

 
 

Skills

• Extensive practical knowledge and application of Medicaid reimbursement rules
  
• Ability to perform all the technical functions of a Medicaid financing initiative including but not limited to:
  

 
 

• Assess potential Medicaid supplemental payments and related transactions in states where Consultant, Senior Strategic Advisor may not have prior knowledge.
  
• Utilize cost reports, disproportionate share (DSH) reports and other large datasets to drive decision points within a project.
  
• Determine all the steps needed to execute a Medicaid financing initiative.
  
• Provide detailed data analysis, models and summaries of the financial impact from policy or methodology changes.
  
• Calculate upper payment limits for a variety of providers and provider classes under the Medicaid program.
  
• Estimate the potential federal funds generated by an initiative as well as the transaction costs.
  
• Assess project data needs and collect the data necessary to carry out the above activities.
  
• Respond to questions and inquiries by the Centers for Medicare and Medicaid Services (CMS) and keep track of recent CMS decisions and decision-making procedures.
  
• Assist clients in developing policies, procedures and structures required to implement the project.
  
• Understanding of the connection between reimbursement, quality and value at both the state and provider levels.
  
• Provide subject matter expertise related to Medicaid managed care, rate development, and metrics related to clinical or financial measurement.
  
• Serve as a mentor to junior staff, leveraging as appropriate to execute client deliverables.
  
• High proficiency in Microsoft Word, Excel, Access required.
  
• Simultaneously balance the needs and timeliness of many projects.
  
• Work closely with the project director and project managers to draft public notices, state plan amendments, 438.6(c) preprints, waiver amendments, memos, workplans, and external or internal progress reports, client-ready spreadsheets and calculations.
  
• Provide technical leadership and explanation to multiple levels of the organization to build internal capacity and foster knowledge management.
  
• Excellent oral and written communication skills including relaying complex technical terms in an easy to understand manner. This includes producing written or pictorial materials for external and internal use and to present calculations in a manner that the client or other staff can reasonably follow.
  
• Ability to interact professionally with clients and other outside audiences.
  
• Work with legal counsel when necessary in designing new payment initiatives.
  
• Attention to detail.
  
• Ability to work independently and in teams.
  
• Time management skills.
  
  
  

Core Behaviors And Competencies

• Build positive relationships within and outside the Firm.
  
• Treat clients, strategic partners and fellow employees with respect and professionalism in all interactions.
  
• Take ownership for one’s professional development by increasing knowledge, skills and abilities in areas that are critical to the Firm’s success.
  
• Collaborate and share knowledge with other Firm staff.
  
• Demonstrate formal and ad hoc team leadership in projects, issues or organizations that are critical to achieving the Firm’s strategic goals.
  
• Be self-motivated, and be an advocate for one’s abilities and talents, both internally and externally.
  
  
  

Key Performance Metrics/Expectations

• Individual performance goals.
  
• Successful completion of deliverables, tasks, projects
  
• Professional development
   
  

We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state, or local law.


If you need a reasonable accommodation for any part of the employment process, please contact us by email at reasonableaccommodations@sellersdorsey.com and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this e-mail address. For more information, view the EEO is the Law Poster and Pay Transparency Statement.


This position requires that you be fully vaccinated against Covid-19. Requests for reasonable accommodation on the basis of disability and/or sincerely held religious beliefs will be provided subject to undue hardship.


Sellers Dorsey maintains a Drug-Free workplace.

 
 

Clipped from: https://www.linkedin.com/jobs/view/associate-director-medicaid-finance-sme-remote-at-sellers-dorsey-3289027465/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Requisition No: 745541

Agency: Office of the Attorney General

Working Title: MEDICAID FRAUD ANALYST II – 41001290

Position Number: 41001290

Salary: $32,697 – $37,000

Posting Closing Date: 10/08/2022

Our Organization and Mission: The Office represents the State of Florida in state and federal civil and criminal courts, from trial courts to the Supreme Court of the United States.

 
 

Pay: $32,697 – $37,000 Annually

 
 

Position Summary: This position is in the Medicaid Fraud Unit. The incumbent in this position provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. The incumbent also performs work conducting detailed research and analysis of investigative information relating to alleged violations of applicable laws pertaining to health care fraud, in the administration of the Medicaid program, and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program. In addition, the incumbent may also perform as the lead analyst on specialized complex civil enforcement investigations and litigation matters, and analytical projects.

 
 

Qualifications: A bachelor’s degree from an accredited college or university and one year of professional experience in research, investigations, investigative analysis, or statistics.
Professional or nonprofessional experience as described above can substitute on a year-for-year basis for the required college education.

 
 

Preference will be given to candidates who have experience compiling and analyzing investigative information, or experience in the use of spreadsheets and relational database applications.

 
 

The Work You Will Do: The responsibilities of this position include, but are not limited to the following:

• 35% Create customized downloads from on-line Medicaid claims data warehouse as requested by investigators, attorneys, and multistate investigative and litigation teams.
  
• 25% Prepare reports/schedules/charts pertaining to all aspects of the analysis and research for use in criminal prosecution, civil actions, and administrative referrals.
  
• 20% Assists and supports Medicaid fraud investigators and attorneys in the compilation and analysis of investigative information and the development of damages models for use in Florida specific and multistate health care fraud investigations and litigation. Obtains and analyzes large amounts of data to interpret and summarize health care fraud activity, calculate damages sustained to the Florida Medicaid program, determine significance, completeness, and usefulness of data, recognize, and identify patterns and trends, and brief investigators and attorneys.
  
• 10% Extract information from investigative databases. Compile, analyze and disseminate intelligence information retrieved from various computer databases/systems. Perform various duties related to computers.
  
• 5% Assist in the prosecution of Medicaid fraud and/or patient abuse to include testimony in courts of law pertaining to the investigation.
  
• 5% Other duties as assigned.
  

 
 

Other Requirements: Experience in compiling and analyzing investigative information to include financial and/or statistical data. Experience in creating reports based on information analyzed for use in criminal, civil, and administrative proceedings. Must have strong computer knowledge in the use of spreadsheet and database applications.

 
 

**SKILLS VERIFICATION TEST** All applicants who meet the screening criteria/minimum job requirements will be required to take a timed Skills Verification Test. Applicants must receive a score of at least 70% to move to the interview phase.

 
 

The Benefits of Working for the State of Florida: Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• Annual and Sick Leave benefits.
  
• Nine paid holidays and one Personal Holiday each year.
  
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance option.
  
• Retirement plan options, including employer contributions (For more information, please click www.myfrs.com).
  
• Flexible Spending Accounts
  
• Tuition waivers.
  
• And more! For a more complete list of benefits, visit www.mybenefits.myflorida.com.
  

 
 

IMPORTANT NOTICE: To be considered for the position, all applicants must:

Submit a complete and accurate application profile necessary for qualifying such as dates of service, reason for leaving, etc. In addition, all applicants must ensure all employment and/or detailed information about work experience is listed on the application (including military service, self-employment, job-related volunteer work, internships, etc.) and that gaps in employment are explained. NOTE: Any required experience and/or preferences listed in the advertisement must be verified at the time of application.

• Ensure that applicant responses to qualifying questions are verifiable by skills and/or experience stated on the employment application and/or resume. Applicants who do not respond to the qualifying questions will not be considered for this position.
  
• The elements of the selection process may include a skill assessment exercise.
  
• Current and future vacancies may be filled from this advertisement for a period of up to six months. Following the six-month period, a new application must be submitted to an open advertisement to be considered for that vacancy.
  
• OAG employees are paid biweekly. All state employees are required to participate in the direct deposit program pursuant to s. 110.113, FS.
  

 
 

CRIMINAL BACKGROUND CHECKS/ DRUG FREE WORKPLACE: All OAG positions are “sensitive or special trust” and require favorable results on a background investigation including fingerprinting, pursuant to s. 110.1127(2)(a), F.S. The State of Florida supports a Drug-Free Workplace, all employees are subject to reasonable suspicion or other drug testing in accordance with section 112.0455, F.S., Drug-Free Workplace Act. We hire only U.S. citizens and those lawfully authorized to work in the U.S.

 
 

E-VERIFY STATEMENT: The Office of the Attorney General participates in the U.S. government’s employment eligibility verification program (e-verify). E-verify is a program that electronically confirms an employee’s eligibility to work in the United States after completion of the employment eligibility verification form (i-9).

 
 

REMINDERS: Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Service System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from SSS. For more information, please visit the SSS website at: https: //www.sss.gov. If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended, or deemed ineligible depending upon the date of your retirement.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.

 
 

Clipped from: https://www.glassdoor.com/job-listing/medicaid-fraud-analyst-ii-state-of-florida-JV_IC1154160_KO0,25_KE26,42.htm?jl=1008168954122&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description

With over 100 offices and nearly 6,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level.  

CBIZ has been honored to be the recipient of several national recognitions:

• 2022 Top Workplaces USA
  
• 2022 Great Place to Work Certification
  
• Top 101 2021 Best and Brightest Companies to Work For in the Nation
  
• 2021 America’s Best Mid-Size Employers
  
• 2021 Best and Brightest Companies in Wellness
  

CBIZ Benefits & Insurance Services is a division of CBIZ, Inc., providing benefits consulting, HRIS technology, payroll, human capital management, property and casualty, talent and compensation solutions, and retirement & investment solutions to organizations of all sizes. CBIZ is ranked as a Top 20 Largest Broker of U.S. Business (Business Insurance Magazine) and a Top 100 Retirement Plan Adviser (PLANADVISER). 

Essential Functions and Primary Duties:

• Assisting patients in applying for financial assistance through Medicaid on behalf of our client facility.
  
• Interviewing patients or authorized representatives via phone or in person to gather information to determine eligibility for medical benefits.
  
• Obtaining, verifying, and calculating income and resources to determine client financial eligibility.
  
• Documenting case records using automated systems to form a record for each client.
  
• Following up with applicants to obtain accurate and complete information within strict timeframes.
  
• Completing/following up on all forms related to Medicaid eligibility.
  
• Performing any additional tasks related to the position assigned by the Manager.
  

 Preferred Qualifications:

• Bachelor’s degree. 
  
• Knowledge of Medicaid and Charity Care.
  
• Experience working in a hospital environment.
  
• Ability to speak and read Spanish.
  

Minimum Qualifications:

• High school diploma/GED.
  
• Must be ambitious and self-directed in a fast-paced environment and can perform in a high volume, multitasking setting.
  
• Must be trustworthy, professional, detail and goal oriented.
  
• Must have exceptional customer service and excellent verbal/written communication skills.
  
• Must be able to learn and work with Medicaid eligibility regulations.
  

REASONABLE ACCOMMODATION

If you are a qualified individual with a disability you may request reasonable accommodation if you are unable or limited in your ability to use or access this site as a result of your disability. You can request a reasonable accommodation by calling

844-558-1414

(toll free) or send an email to

accom@cbiz.com

.

EQUAL OPPORTUNITY EMPLOYER

CBIZ is an affirmative action-equal opportunity employer and reviews applications for employment without regard to the applicant’s race, color, religion, national origin, ancestry, age, gender, gender identity, marital status, military status, veteran status, sexual orientation, disability, or medical condition or any other reason prohibited by law. If you would like more information about your EEO rights as an applicant under the law, please visit these following pages EEO is the Law and EEO is the Law Supplement.

PAY TRANSPARENCY PROTECTION NOTIFICATION

 
 

Clipped from: https://careers.cbiz.com/en-US/job/medicaid-eligibility-specialist-ka-consulting/J3N5LH69LNY8LH0D125?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Humana Healthy Horizons in Louisiana is seeking an Associate Director, Care Management(Behavioral Health) who will use clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. He/she will lead teams of nurses and behavioral health professionals responsible for care management. The Associate Director, Care Management requires a solid understanding of how organization capabilities interrelate across department(s). They will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.

Responsibilities

The Associate Director, Care Management (Behavioral Health) leads and guides others in providing integrated services to and for our customers. Provides ongoing associate coaching and feedback to enhance associate contribution, competency, and performance.

• Oversees day to day operations and associates for Louisiana Medicaid Care Management.
  
• Achieve performance metrics for a fast paced comprehensive case management environment.
  
• Assure compliance with mandated and corporate policies regarding other departmental areas such as medical management, utilization management and case management.
  
• Develop team members and creates department process flows.
  
• Will directly lead multiple managers and highly specialized professional associates.
  
• Oversees the assessment and evaluation of members’ needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members.
  
• Maintain compliance with Louisiana Department of Health (LDH), Department of Health and Human Services (DHHS), and the Centers for Medicare and Medicaid Services (CMS) guidelines and contractual requirements.
  
• Decisions are typically related to identifying and resolving complex technical and operational problems within department(s).
  

               
 

Required Qualifications

• Must reside in the state of Louisiana.
  
• Unrestricted Registered Nurse (RN) license in the state of Louisiana OR Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Physicians (Psychiatrists), Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
  
• Minimum five (5) years of previous clinical experience.
  
• Minimum of five (5) years of management/supervisory experience in the healthcare field.
  
• Proficiency in analyzing and interpreting data trends.
  
• Progressive business consulting and/or operational leadership experience.
  
• Comprehensive knowledge of Microsoft Office applications including, PowerPoint Word, Excel, and Outlook.
  
• Demonstrated knowledge of keyboard, Word, Excel, PowerPoint, email, and other Office software applications.
  
• This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least100,000/300,000/100,000limits.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Bachelor’s or Master’s Degree in nursing, public health, health administration, health policy or business.
  
• Knowledge of Humana’s internal policies, procedures and systems.
  
• CCM (Certified Care Manager).
  
• Experience with health promotion, coaching and wellness.
  
• Knowledge of community health and social service agencies and additional community resources.
  

Additional Information

• Workstyle: Hybrid Home – Works 1 – 2days/week in Humana’s Baton Rouge or Metairie, LA office location and 3 – 4 days remotely.
  
• Travel: Up to 25% of the time within the state of Louisiana.
  
• Direct Reports: Up to 8 Managers/Associates.
  
• Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#LouisianaMedicaid

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.ziprecruiter.com/c/004-Humana-Insurance-Company/Job/Associate-Director,-Care-Management(Behavioral-Health)-Louisiana-Medicaid/-in-Thibodaux,LA?jid=43bdfb1e3a1f842a&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview

Health Payer IT Project Manager (Claims/Medicare/Medicaid) Jobs in United States at Apex Systems

Title: Health Payer IT Project Manager (Claims/Medicare/Medicaid)

Company: Apex Systems

Location: United States

Apex Systems has an Immediate Need for multiple (100% Remote) Health Payer IT Project Manager !! These will be estimated 12+ Month “Contract to Possible Permanent Hires” supporting one of our Largest Healthcare Clients on the East Coast. Please see below for all details.

Job Title:Health Payer IT Project Manager

Contract Pay Rate:$50.00 – $55.00 / Hourly Rate(Dependent on Experience)

Location:** 100% Remote **

Contract Type:12 Month “Contract to Possible Permanent Hire”

Requirements

3+ Years of Healthcare Payer Experience ( Understanding what a Claim is, where is goes, who are the providers, how to merge two lines of business)

4+ Years as an official Project Manager

Job Description:

Work with Business and IT Stakeholders to understand the parameters (Scope, Schedule, and Cost) of projects.

Develop a detailed project plan to monitor and track progress

Tracks milestones, deliverables, and change requests.

Manage changes to the project scope, project schedule and project costs using appropriate verification techniques

Report and escalate to management as needed

Perform risk management to minimize project risks

Establish and maintain relationships with third parties/vendors

Create and maintain comprehensive project documentation

Serves as a liaison to communicate information regarding changes, milestones reached, and other pertinent information.

Works with limited guidance and is responsible for applying project management knowledge, skills, tools and techniques to project deliverables, processes, and systems.

Operates within defined parameters using project management methodology.

Show more

Clipped from: https://pharmajobs.me/job/health-payer-it-project-manager-claims-medicare-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description
Location – Work From Home

Responsible for managing foundational and strategic compliance responsibilities

Regulator/Customer Relationship Management

• State regulator and Health Plan communications (ad hoc issue resolution, coordination and support of operational updates, remediation of member and provider concerns, response to fines and sanctions, etc.)
  
• State filings review (member and provider communications, vendor subcontracts, reporting, corrective action plans, etc.)
  
• Regulator audit support and coordination
  

Strategic Advisory and Consulting

• Contract and regulatory subject matter expertise and business strategy consultation, from new business development to operational continuity
  
• Contract and regulatory market research requests
  

Compliance Monitoring and Oversight

• Compliance risk and issue identification, assessment, and remediation management
  
• Development and maintenance of Compliance resources (market comparisons, policies and procedures, etc.)
  
• Coordination of Health Plan response to corrective action plans, regulator penalties, and audit findings
  
• Marketing and communication oversight
  
• Plan compliance training
  
• Special Investigations Unit (SIU) support and engagement
  

Minimum Qualifications

• Requires a BA/BS and minimum of six years health care, regulatory, ethics, compliance, or privacy experience; or any combination of education and experience, which would provide an equivalent background.
  
• Ability to work in a hybrid environment, including from an external office, and at least monthly travel to Anthem’s Indianapolis offices
  

Preferred Qualifications

• MS/MBA/JD or professional designation preferred
  
• Medicaid or managed care experience preferred
  
• Demonstrated record of strong written and oral communication skills
  
• Intermediate to advanced level of proficiency using Microsoft Office products (Outlook, Word, Excel, PowerPoint, SharePoint, Teams, OneNote, etc.)
  

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 careers.ElevanceHealthinc.com. 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 ability@icareerhelp.com for assistance.

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.

Clipped from: https://www.ziprecruiter.com/c/Elevance-Health/Job/Compliance-Manager-(Indiana-Medicaid)/-in-Indianapolis,IN?jid=7a78722fffc62f9f&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Large Managed Care Company hiring 15 Medicaid/Medicare Enrollment Representives. Candidates can sit in either Central, Mountain or Pacific Time Zone. 100% remote-based and computer equipment will be provided.

Initial 3-month contract with strong possibility of contract extensions and/or conversion to permanent hire.

Shift times Monday through Friday 8am until 4:30pm in candidate’s time zone.

Target Start Date: 10/3/2022

Title: Membership Representative II

KNOWLEDGE, SKILLS & ABILITIES

• Conducts direct outreach to new Medicare members to provide personal assistance with their new MAPD, DSNP, and MMP plans. Serves as an advocate to ensure members are well informed about plan benefits, provider options and how to use their new plan benefits.

• Serve as the member’s navigator during the onboarding process and address any plan questions and anticipate any issues that may arise. Determine the nature of the member’s needs and interests; inform members of their plan resources and benefits with a focus on the member’s area of interest/needs; and follow up with member to ensure needs are met and member is having a positive plan experience. Develop relationship with member to be the go-to person with any future issues or questions.

• Log all contacts in a database.

• Participate in Member engagement work groups as needed to ensure Medicare member needs are being anticipated and addressed.

• Participates in regular member benefits training with health plan, including the member advocate/engagement role.

JOB FUNCTION:

Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including:

New Member Onboarding, member plan benefits education, and the development/maintenance of Member Materials.

REQUIRED EXPERIENCE:

2 years experience in customer service, consumer advocacy, and/or health care systems. Experience conducting intake, interviews, and/or research of consumer or provider issues. Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager. Experience with Medicare and Medicare managed plans such as MAPD, DSNP, and MMP. (Preferred)

PREFERRED EDUCATION:

Associate’s or Bachelor’s Degree in Social Work, Human Services, or related field.

Job Type: Full-time

Pay: Up to $20.00 per hour

Schedule:
8 hour shift
Monday to Friday

Application Question(s):
Do you live in the Central, Pacific or Mountain Time Zones?

Experience:
Healthcare Customer Service: 2 years (Preferred)
Conducting intake and interviews for healthcare: 1 year (Preferred)
Medicare/Medicaid Managed Care Plans: 2 years (Preferred)

Clipped from: https://jobs.ksnt.com/jobs/medicare-medicaid-membership-representative-ii-dallas-texas/712452937-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

List of Jobs and Events

 
 

Advisory Services Analyst – Medicaid

Mathematica Milford Mill, MD Full-Time

• 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. Learn more about our benefits here: [ Link removed ] – Click here to apply to Advisory Services Analyst – Medicaid

 

Mathematica is searching for analysts with experience in Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, data analytics, and outcomes of innovative programs and policies. Additionally, Medicaid analysts will work on or support project management, change management, and business development. Medicaid analysts work on a variety of projects spanning policy and programmatic areas. These projects range from data analytics to program evaluation and implementation support. Candidates do not need to have experience in all of these areas but should have substantial experience in at least one of them.

Medicaid analysts will likely be connected to 2-3 projects at a time, with many projects requiring team leadership and direct-client contact. Across all projects, Medicaid analysts are expected to:

• Lead or participate actively and thoughtfully in multidisciplinary teams to implement and monitor policy and programs, drawing on your past experience with Medicaid programs
  
• Apply rigorous analytic thinking to the collection and interpretation of quantitative and/or qualitative data, including analysis of Medicaid administrative data, managed care data, and site visits or telephone interviews with state and federal officials, health plan representatives, and providers
  
• Bring creative ideas to the development of proposals for new projects
  
• Provide the direction and organization needed to help keep projects on time and on budget and facilitate communications across and between internal and external stakeholders
  
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  

Specific project or new business development activities may include:

• Conducting research projects on topics related to state and federal Medicaid policy
  
• Providing technical assistance to federal and state Medicaid stakeholders
  
• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
  
• Developing technical specifications, user manuals, and other documentation to support the implementation of reporting systems and analytic tools
  
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, and webinar presentations
  

 
 

• Position Requirements*:
  

Qualifications:

• Masters degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field, and at least 3 years of experience working in health policy or health research, with a substantial portion of that time focused on some aspect of the Medicaid program at the state or federal level; or a bachelors degree and at least 7 years of state or federal Medicaid experience.
  
• Strong foundation in quantitative and/or qualitative methods and a broad understanding of Medicaid program and policy issues
  
• Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
  
• Demonstrated ability to lead tasks or deliverables and coordinate the work of multidisciplinary teams
  
• Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines
  

To apply, please submit a cover letter, resume, transcripts (unofficial are acceptable), and contact information for three references. Please also provide a writing sample that demonstrates policy analysis or program operation and monitoring skills, and reflects independent analysis and writing, such as a white paper or decision memo. You will also be asked to provide your desired salary range during the application process.

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; Remote

This position offers an anticipated annual base salary range of $70,000 – $95,000. This position may be eligible for a discretionary bonus based on individual and company performance.

In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Recommended Skills

• Administration
  
• Analytical
  
• Attention To Detail
  
• Business Development
  
• Claim Processing
  
• Communication
  

 
 

Clipped from: https://www.careerbuilder.com/job/J3Q8D0777HQL58P7GYT?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Location: Long Bch / California

 
 

Employment type: Full-Time

Job Description

Job Summary

Provide screening of candidates toward identification of qualified, eligible prospects related to both long-term care needs and Medicaid coverage for enrollment. Assist our current members with renewing Medicaid coverage and ensure that all program participants are enrolled in and maintain all applicable benefits and entitlements.

Knowledge/Skills/Abilities

• Outreach prospects who may qualify for enrollment
  
• Conducts pre-screening for prospect Medicaid eligibility to assist prospect/member with Medicaid eligibility/coverage
  
• Participates in the care team for continuous performance improvement: facilitates problem-solving for performance improvement; contributes to the team’s efforts to every member with respect, courtesy and fairness in a way that provides superior customer service
  
• Educates and provides assistance to members and/or families with the completion and submission of Medicaid re-certification applications for potential and active members as needed via telephone and home visits.
  
• Assists members with Medicaid re-certification package.
  
• Educates, verifies, and gathers budget information and documents for members who have surplus or pooled trust.
  
• Conduct home visits as needed to assist in completion of documents.
  
• Submit documentation to state agency within specified time-frame to assure Medicaid coverage for participant.
  
• Tracks the Medicaid eligibility status via state agency’s system and Medicaid hotline for all prospect and active members. Assists internal teams in verifying Medicaid eligibility through state agency enrollment system.
  
• Monitors Medicaid re-certification time frames for each active member and maintain records on coverage status and recertification.
  
• Documents all member contact and documentation regarding recertification in appropriate system.
  
• Notifies member of upcoming loss of eligibility and assists in safe transition for disenrollment.
  
• Maintains the highest level of integrity, courtesy, and respect while interacting with prospects and active members, employees, and business contacts.
  
• Excellent communication, interpersonal, decision-making and customer service skills for frequent interaction with prospects and active members and internally with other business associates.
  
• An independent thinker with a history of creating solutions to achieving goals with ability to work in a continuous quality improvement mode
  
• Aptitude for using a fast-paced proactive vs. reactive approach maneuvering multiple tasks simultaneously including seamlessly changing priorities.
  
• Significant electronic records management capabilities for moving around in a database and entering information.
  
• 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.
  

Job Qualifications

Required Education:

• High School Diploma or equivalent
  

Preferred Education:

• Associates Preferred
  

Required Experience:

• 2+ years of experience with Medicaid eligibility, screening, application process, review, determining eligibility, recertification or processing.
  
• Proficiency in navigating the internet and multi-tasking with multiple software / electronic documentation systems simultaneously.
  
• Experience with a Corporate email system including calendar functionality, as well as Microsoft.
  
• Role specific industry experience in Long-Term (LT) or Managed Long-Term Plan (MLTCP).
  
• Experienced in one or more of the following additional areas: health insurance, home care environment, acute or sub-acute
  

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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://molina-healthcare.talentify.io/job/coord-medicaid-entitlement-long-bch-california-molina-healthcare-2015459?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic