Category: Curator- Job Hunter

 
 

Position Description:

Patient Account Rep- Medicaid, Patient Financial Services, Full-Time, Days

We are looking for a Patient Account Representative- Medicaid to join our Patient Financial Services team in Albuquerque, NM.

This full-time job is located withLovelace Shared Services,organizational support departments for all Lovelace facilities including Coding, Finance, Health Information Management, Revenue Cycle, Marketing, and the Resource Team.We are dedicated to exceeding our customers’ expectations in every way.

Patient Account Representative- Medicaid Job Responsibilities:



 

• Responsible forcollecting insurance accounts for government and commercial payers.
  

 
 

• Manages and reconciles accounts, update and document financial data.
  

 
 

• Under general supervision, ability to prioritize and complete A/R collections in accordance with departmental policies and procedures within established deadlines for hospital claims.
  

 
 

• The ability to update and document financial data, utilizing excellent customer service skills to contact patients and insurance carriers to ensure accurate reimbursement.
  

 
 

• Insurance Follow-Up/Denials
  

 
 

• Commercial Insurance Follow Up- Denials/Appeals escalation spreadsheets reviews
  

 
 

• Medicaid Insurance Follow Up- Credits/Denials/Appeals/ Overpayment Variance
  

 
 

• Military/ IHS Insurance Follow Up- Credits/Denials
  

Position Requirements:

Patient Account Representative- Medicaid Education and Experience JobRequirements:

 

• High school diploma or equivalent
  

 
 

• One to two (1-2) years previous customer service experience desired
  

 
 

• Ability to communicate effectively verbal and written
  

 
 

• Ability to work independently
  

 
 

• Must have computer skills with basic knowledge of Microsoft Word, Microsoft Excel and Microsoft outlook
  

 
 

• General Accounting and bookkeeping skills
  

 
 

• Strong customer service and interpersonal skills
  

Why Lovelace?


 

• Namedoneofthe150GreatPlacestoWorkinHealthcarebyBecker’sHospitalReview
  
• NamedoneoftheBestPlacestoWorkbyAlbuquerqueBusinessFirst
  
• NamedTopWorkplacebyAlbuquerqueJournal,2013, 2014and2015
  
• NamedtoModernHealthcare’s100BestPlacestoWorkfive timessince2008
  

Lovelace is a drug-free employer with smoke free campuses.

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.
 

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Description


SHIFT: Day Job


SCHEDULE: Full-time


Be part of an extraordinary team.


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?


RN Nurse Utilization Management l (Inpatient) (PS66175)


Location: Residence in the state of Tennessee required. This is a work@home position. Qualified applicants must reside within a reasonable commute to an Anthem office for training and technical needs.


How You Will Make An Impact


The Nurse Medical Management l for the Tennessee Health Plan is a member of the UM In-Patient Team and responsible for collaboration with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.


Primary Duties May Include, But Are Not Limited To

• Conducts review of initial and concurrent authorization requests for skilled nursing, acute and elective in-patient rehabilitation, long term acute care reviews, and acute in-patient to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  
• Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  
• Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning.
  
• Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  
• Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
   
  

Qualifications


Minimum Requirements:

• Current active unrestricted RN license to practice as a health professional in state of residence and 2 years acute care clinical experience or case management, utilization management or managed care experience, which would provide an equivalent background.
   
  

Preferred Skills, Capabilities And Experiences

• Pediatric nursing experience is preferred.
  
• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
  
• Prior managed care experience preferred.
  
• Strong computer skills
   
  

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 Anthem. 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 Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

 
 

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*It’s Time For A Change..

.
* *Your Future Evolves Here* Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day.

We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian.

We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it..

*What You’ll Be Doing:* Essential Functions + Maintain accurate member records. Enter eligibility and/or enrollment data into Aldera system on a daily basis including new enrollees, change in circumstance terminations, PCP’s, broker and other information. + Review 834 X12 files during the Aldera system load process.

Research and work any discrepancies or errors. + Adjust premiums and rates for financial billing. + Resolve client and internal ticket requests.

+ Correspond and communicate with the groups, brokers, and clients through tickets, workflows and emails. + Meet minimum daily production requirements and produce high-quality work consistently. + Generate and/or work reports (daily, weekly, monthly.

) + Adhere to existing and new policies and procedures specific to each client. + All other duties as assigned. Education and Experience + High school diploma, 4 year college degree or equivalent experience required.

+ Medicaid policy and EDI knowledge preferred. + Experience coordinating with healthcare clients and/or payers to execute enrollment related activities. + Interpersonal skills to work well within a team that includes all levels within the organization from clerical and support staff to senior management as well as clients and brokers outside of the organization.

+ Ability to work independently, prioritize and work under deadlines. Attention to detail. + Understands and can work in a production environment in which performance is tied to operational metrics. + Integrity and discretion to maintain confidentiality of member’s HIPAA data.

+ Proficient in Microsoft Office (Outlook, Excel, Word.).*Technical requirements:* Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router.

These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply.

We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption..

*Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.* Compensation Range: The typical range of employees within the compensation grade of this position is . Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts..

 

Web Reference : AJF/270006290-24
Posted Date : Wed, 26 Jan 2022

 
 

Please note, to apply for this position you will complete an application form on another website provided by or on behalf of Evolent Health. Any external website and application process is not under the control or responsibility of Careers 4 Professionals

 
 

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Washington, United States Anthem, Inc. Full time

MILITARY VETERANS

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.

Director Quality Management Plan Medicaid

Location: Washington DC

Anthem supports a hybrid workplace model with pulse point sites used for collaboration, community, and connection. Position is currently remote until our return to office is implemented, which at that point, position will be part of our hybrid workplace model.

Director Quality Management Plan Medicaid is responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.

Primary duties may include, but are not limited to:

• Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan.
  
• Promotes understanding, communication, and coordination of the quality management program.
  
• Directs and provides leadership for compliance with National Committee for Quality Assurance (NCQA) standards.
  
• Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys.
  
• Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and district contractual requirements.
  
• Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year round medical record review, and over read processes.
  
• Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.
  
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  

Qualifications

Minimum Requirements:

• Requires a BA/BS in a health or business related field; 8 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
  

Preferred Qualifications:

• MSN, MPH, or MPA preferred.
  
• Current clinical license preferred.
  
• CPHQ Certification preferred.
  
• CQM experience in a Managed Care Organization highly desired.
  

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 Anthem. We require all new candidates to become vaccinated against COVID-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide and Anthem approves a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

 
 

Clipped from: https://us.trabajo.org/job-640-20220126-ed54a2410480585258cfb33ff6b96a91?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.


Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.


A program that puts the individual first


They Are


Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.

• Emphasize a personalized care experience,
  
• Improve care for children and adults with complex behavioral health needs,
  
• Improve wellness and health outcomes,
  
• Support providers in better patient care and
  
• Increase program transparency and accountability.
  
  
  

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Working Title: Provider Engagement Specialist


Classification: Medicaid Health Systems Specialist (PN 20046417)


Office: Operations


Bureau: Business Operational Support, Provider Relations


Job Overview


As a Provider Engagement Specialist on the Provider Relations team at the Ohio Department of Medicaid (ODM), your responsibilities will include:

• Resolve institutional provider complaints submitted through HealthTrack; ensure Managed Care Organizations (MCOs), MyCare, and OhioRISE are meeting provider agreement requirements
  
• Assist with oversight of the Claims Payment Systemic Errors for MCOs and OhioRISE
  
• Participate in Provider Advisory Council (PAC) meetings, review PAC reports, ensure the needs of our providers are met
  
• Assist with oversight of the MCO and OhioRISE provider representative requirement
  
• Research and resolve managed care provider claim inquiries
  
• Respond to escalated fee-for-service (FFS) institutional provider claim inquiries
  
• Conduct institutional FFS provider consultations as needed
  
• Attend meetings and seminars, deliver presentations, and create training material
  
• Collaborate with internal and external stakeholders across departments and levels, state agencies, and Managed Care Entities (MCEs) to improve provider engagement and the health care delivery system
  
  
  

Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.

• Or 24 months experience as Medicaid Health Systems Analyst, (65291).
  
• Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required.
  
  
  

Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 4


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Bargaining Unit


Schedule


Full-time


Work Hours


8:00 a.m. – 5:00 p.m.


Compensation


$30.03/per hour


Unposting Date


Feb 8, 2022, 11:59:00 PM


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

 
 

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Supplemental Information

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Financial Management and Operations / EBR Parish.


Announcement Number: MVA/SAG/2291
Cost Center: 305-2070200
Position Number(s): 2962


This vacancy is being announced as a Classified position and may be filled as a Job appointment, Probationary or Promotional appointment.


(Job appointments are temporary appointments that may last up to 48 months)


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.*


A resume upload will NOT populate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit


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.


For further information about this vacancy contact:
Sanaretha Gray

Sanaretha.Gray@la.gov
LDH/HUMAN RESOURCES
BATON ROUGE, LA 70821
225 342-6477


This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

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.

Clipped from: https://www.indeed.com/viewjob?jk=7b60cbd6864be74d&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Mercer

 
 

 Phoenix, AZ Full Time

Job Posting for Medicaid Consultant – Policy & Operations at Mercer

Mercer is seeking candidates for the following position. Candidates can be based in our D.C., Phoenix, Atlanta, Minneapolis office:

Medicaid Consultant — Medicaid Policy and State Operations

What can you expect?

• The Medicaid Consultant will participate in and help lead projects with GHSC’s clients
  
• Our clients are primarily State Medicaid and Children’s Health Insurance Program (CHIP) agencies and related agencies responsible for Medicaid and CHIP fee-for-service and managed care programs
  
• Some of the responsibilities of this role include providing Medicaid and CHIP policy options and operational expertise, project management, team management and client management.
  

What is in it for you?

• Work for an industry leader with a dynamic and inclusive culture
  
• An opportunity to work in a small-team environment with a multi-disciplinary point of view
  
• Make an impact by helping vulnerable populations through the development of meaningful programs
  
• Excellent growth/advancement opportunity
  

We will count on you to:

• Participate as a team member and help lead projects to help states develop, implement and improve their Medicaid and CHIP programs
  
• Manage a variety of state Medicaid/CHIP projects, which includes:
  
• Managing project logistics, timelines, and milestones to ensure successful project execution
  
• Participating as a member of the consulting team in developing overall client strategy
  
• Managing the quality and timeliness of client deliverables and communicating regularly with the project team
  
• Helping to develop budgets and billing reports
  
• Participating in client calls and meetings, as appropriate
  
• Identifying and allocating resources, ensuring work is delegated to the appropriate skill and career level, providing team members opportunity to develop skills and experience
  
• Assisting with the preparation and timely delivery of clear and concise project team and client communications
  
• Support program and policy research analyses. Examples include:
  
• Policy Analysis –review and analyze state and federal Medicaid policy to inform program options
  
• Contract Analysis – review external vendor and managed care organization contracts, state plans, federal waivers and other documents (e.g., policies, manuals) to ensure compliance with regulatory requirements and contract standards or to develop best practice contract requirements for a client
  
• Research-based Analysis – review and summarize articles from nationally recognized journals on select health care topics such as value-based purchasing, procurement, behavioral health and long-term services and supports
  

What you need to have:

• BA/BS degree or higher
  
• 3-5 years of relevant experience
  
• Foundational knowledge of Medicaid managed care
  
• Excellent organization, project management and interpersonal skills
  
• Ability to prioritize and handle multiple tasks in a demanding work environment
  

What makes you stand out?

• Experience working for a state Medicaid/CHIP program or CMS
  
• Experience with Medicaid managed care data and reporting
  
• Project management certification (PMP) or demonstrated project management experience
  
• Demonstrated ability to thrive in a remote working environment
  

To learn more about Mercer’s GHSC practice, please visit www.mercer-government.mercer.com Mercer believes in building brighter futures by redefining the world of work, reshaping retirement and investment outcomes, and unlocking real health and well-being. Mercer’s more than 25,000 employees are based in 44 countries and the firm operates in over 130 countries. Mercer is a business of Marsh & McLennan (NYSE: MMC), the world’s leading professional services firm in the areas of risk, strategy and people, with 76,000 colleagues and annual revenue of $17 billion. Through its market-leading businesses including Marsh, Guy Carpenter and Oliver Wyman, Marsh & McLennan helps clients navigate an increasingly dynamic and complex environment. For more information, visit https://www.me.mercer.com/. Follow Mercer on Twitter @Mercer.

Mercer LLC and its separately incorporated operating entities around the world are part of Marsh & McLennan Companies, a publicly held company (ticker symbol: MMC).

Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.

 
 

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Humana

 
 

 Cincinnati, OH Remote Full Time

Job Posting for EPSDT Maternal Child Health Professional (Medicaid) – Remote Ohio at Humana

The Senior Quality Compliance Professional works with physicians/physician groups to ensure highest accountability of compliance and quality. The Senior Quality Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Quality Compliance Professional uses quality compliance and improvement tools and methodology to assess, implement, and evaluate activities to monitor and continuously improve EPSDT and maternal health services and rates for Ohio Medicaid enrollees. The Senior Quality Compliance Professional has proven data analysis skills and a strong knowledge of EPSDT and maternal health requirements. The Senior Quality Compliance Professional is frequently required to interpret and analyze data to identify new creative interventions to increase EPSDT screening rates, improve access to pregnancy related services, independently determine an appropriate course of action, and present these ideas/plans to governance teams/committees. They assess educational needs of internal and external teams around EPSDT and maternal health services in order to develop and implement plans to increase knowledge.

The primary functions of this role include:

• Ensure member receipt of all EPSDT/HealthChek Services;
  
• Ensure member receipt of maternal health and postpartum care;
  
• Promote family planning services;
  
• Promote preventive health strategies;
  
• Identify and coordinate assistance for identified member needs specific to maternal/child health and EPSDT;
  
• Interface with community partners and pregnancy related services coordinators;
  
• Participate in EPSDT, maternal health and child quality performance improvement efforts; and
  
• Must reside in the state of Ohio and be available to travel for periodic meetings
  

Required Qualifications

Senior Quality Compliance Professional must meet one of the following requirements:

• Unrestricted Registered Nurse in the State of Ohio OR
  
• Physician’s Assistant OR
  
• Master’s degree in health services, public health, or health care
  
• administration or another related field OR
  
• Certified Professional in Health Care Quality (CPHQ) OR
  
• Certified Health Care Quality Management (CHCQM)
  

Senior Quality Compliance Professional must meet all of the following:

• At least 3 years of experience in either delivering EPSDT services OR Health Care Quality Improvement
  
• Prior experience in a fast paced insurance or health care setting
  
• Knowledge of EPSDT and Child Health Services
  
• Knowledge of Maternal and Pregnancy related services
  
• Understanding of healthcare quality measures (example HEDIS)
  
• Comprehensive knowledge of Microsoft Office Outlook, One Note, Visio, Word and PowerPoint
  
• Advanced Excel experience (pivot tables, charts, formulas)
  
• Excellent communication skills, both oral and written, ability to present to large groups
  
• 10% travel for meetings within the State of Ohio (see additional information)
  
• For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
  

If progressed to offer, you will be required to:

• Provide proof of full vaccination or commit to testing protocols OR
  
• Provide proof of applicable exemption including any required supporting documentation
  
• Medical, religious, state and remote-only work exemptions are available.
  

Work At Home Requirements

• Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
  
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
  

Preferred Qualifications

• Certified Professional in Health Care Quality (CPHQ)
  

 
 

• Advanced Practice Provider (Physician Assistants; Nurse Practitioner, Certified Nurse Midwife)
  

 
 

• Experience developing provider and member education
  
• Knowledge of Humana’s internal policies, procedures and systems
  

Additional Information

Onsite Travel

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.salary.com/job/humana/epsdt-maternal-child-health-professional-medicaid-remote-ohio/j202201242131310690831?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Position Overview: Process assigned medical claims pended for manual adjudication in assigned workflow roles. Accurately interpret benefit and policy provisions applicable to line of business. Review claim to determine coverage based on contract, provider status, and claims processing guidelines.

Essential Responsibilities:

• Review and accurately process assigned medical claims that pend for manual adjudication in claims processing workflow roles according to member’s plan benefits and department claims processing policies and procedures.
  
• Verify accuracy of data entry including patient information, procedure and diagnosis codes, amount(s) billed, and provider data.
  
• Review plan benefits and determine coverage based on contract and claims processing guidelines.
  
• Use ‘notes’ system to record pertinent information involving a claim or member.
  
• Review claims set-aside for further action and ensure they are released in a timely manner.
  
• Document issues that affect claims processing quality and advise team leader of claims processing concerns and/or problems.
  
• Provide feedback on standard operating procedures for continual process improvement.
  
• Provide assistance to other internal departments in responding to questions regarding claims processing.
  
• Provide back-up for Claims Analyst I role.
  

Supporting Responsibilities:

• Regularly attend department, team meetings, and daily team huddle.
  
• Meet department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  
• Perform other duties as assigned.
  

Work Experience: One year work experience in a general office role required, or a combination of equitable work and education experience required. Health related experience preferred.

Education, Certificates, Licenses: High school diploma or equivalent required.

Knowledge: Ability to develop thorough understanding of PacificSource products, plan designs, provider/network relationships and health insurance terminology. Research skills and ability to evaluate claims in order to enter and process accurately. Preferred computer skills include keyboarding and 10-key proficiency, basic Microsoft Word and Excel. Ability to prioritize work and perform under time constraints with minimal direct supervision. Ability to utilize Lean principles and provide claims mentorship to other team members. Team player willing to collaborate and help others accomplish team objectives. A fundamental understanding of self-insured business is helpful.

Competencies

• Adaptability
  
• Building Customer Loyalty
  
• Building Strategic Work Relationships
  
• Building Trust
  
• Continuous Improvement
  
• Contributing to Team Success
  
• Planning and Organizing
  
• Work Standards
  

Environment:

• Work inside in a general office setting with ergonomically configured equipment.
  
• Travel is required approximately 5% of the time.
  

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
  
• We are one team working toward a common goal.
  
• We are each responsible for customer service.
  
• We practice open communication at all levels of the company to foster individual, team and company growth.
  
• We actively participate in efforts to improve our many communities-internally and externally.
  
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  
• We encourage creativity, innovation, and the pursuit of excellence.
  

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

 
 

Clipped from: https://getwork.com/details/62b9addd6b047bbf7d1b75d8e22116ca?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Requisition No: 558546


Agency: Agency for Health Care Administration


Working Title: 68058970 – AGENCY FOR HEALTH CARE ADMINISTRATOR-SES


Position Number: 68058970


Salary: $1,783.81 – $2,307.69 Bi-Weekly


Posting Closing Date: 01/31/2022


This is an exciting opportunity to help shape the quality of health care in Florida. The Agency for Health Care Administration (AHCA) is the State of Florida agency responsible for oversight of the Medicaid program. The Medicaid program provides low-income families and individuals with access to health care. If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.


We are seeking to hire an AHC Administrator – SES who desires to work to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team-based work environment.


You will become a team member of the Bureau of Medicaid Fiscal Agent Operations (MFAO). MFAO provides oversight and monitoring of the Agency’s Medicaid fiscal agent; responsible for the processing of Florida Medicaid claims and multiple supporting systems; ensuring Medicaid providers are properly enrolled into the program, Medicaid recipients receive proper coverage, enrollment into managed care plans; extracting, analyzing, and/or reporting Medicaid data; and ensuring that new Agency systems are planned and procured.


This position is responsible for providing management and consultative services and will lead, plan, coordinate, and supervise the Compliance Reporting and Claims/Encounter Support Unit. The unit reviews operations of the Florida Medicaid Management Information System (FMMIS) to assure continued certification of the FMMIS, to assure timely and appropriate registration of providers, to assure timely and appropriate payment of claims, and to assure accurate production of reports. Identify discrepancies and track resolution of problems.


You will monitor all phases of the fiscal agent’s operations, analyze the quality of the contractor’s performance in meeting the contractual standards, develop performance standards, coordinate activities related to claims resolution, coordinate activities related to encounter processing including health plan support and monitoring of encounter errors.


We are looking for a candidate with up-to-date knowledge concerning the Florida Medicaid program, including pertinent Federal laws and regulations, state statutes and rules, and the Florida Medicaid State Plan. An ideal candidate will be informed about the operations of the Medicaid fiscal agent including Medicaid claims processing, billing procedures, reimbursement methodologies and provider enrollment. Maintains knowledge of procurement processes.


AHCA Offers An Excellent Array Of Benefits, Including

• Health insurance
  
• Life insurance
  
• Dental, vision and supplemental insurance
  
• Retirement benefits
  
• Vacation and sick leave
  
• Paid holidays
  
• Opportunities for career advancement
  
• Tuition waiver for public college courses
  
• Training opportunities
   
  

For more information about the Bureau of Medicaid Fiscal Agent Operations, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.


Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”


Knowledge, Skills, And Abilities

• Knowledge of Florida Medicaid Management Information Systems (FMMIS).
  
• Knowledge of methods used in data collection and analysis.
  
• Knowledge of management principles and practices.
  
• Ability to collect, evaluate and analyze data to develop alternative recommendations, solve problems, document workflow and other activities relating to the improvement of management practices.
  
• Ability to organize data into logical format for presentations in reports, documents, and other written material.
  
• Ability to supervise, mentor and train staff.
  
• Ability to conduct fact finding research and document clear and concise results.
  
• Ability to utilize problem solving techniques and make decisions.
  
• Ability to work independently.
  
• Ability to determine work priorities, assign work and ensure proper completion of work assignments.
  
• Ability to communicate effectively verbally and in writing.
  
• Ability to establish and maintain effective working relationships with others.
  
• Ability to develop training materials and conduct training sessions.
   
  

Minimum Qualifications Requirements

• Minimum of five years’ experience in staff and project leadership
  
• Minimum of three years’ experience working with vendors, contract compliance and contract monitoring
  
• Minimum of five years of experience performing healthcare system and management analysis
   
  

Licensure, Certification, Or Registration Requirements


N/A


CONTACT: DEBORAH KELLEY 850-412-3449


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.

Clipped from: https://www.linkedin.com/jobs/view/68058970-agency-for-health-care-administrator-ses-at-state-of-florida-2893760567/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic