Category: MM Curator

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

POSITION TITLE: Medicaid Implementation Administrator (55% travel)

CONTRACT LENGTH:12M

GRADE: 27

 
 

Job Family – Finance & Accounting

 
 

JOB SUMMARY

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

 
 

MAJOR DUTIES & RESPONSIBILITIES

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

 
 

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

 
 

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

 
 

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

 
 

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

 
 

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

 
 

7. Performs other job-related duties as assigned.

 
 

EDUCATION: Bachelor’s Degree

 
 

WORK EXPERIENCE : 1-3 years

 
 

TYPE OF SKILL AND/OR REQUIRED LICENSING/CERTIFICATION

PeopleSoft preferred, Microsoft Office, SAP preferred, Chancery preferred

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

 
 

LEADERSHIP RESPONSIBILITIES

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

 
 

WORK COMPLEXITY/INDEPENDENT JUDGMENT

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

 
 

BUDGET AUTHORITY

Participates in a group plan and/or budget development.

 
 

PROBLEM SOLVING

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

 
 

IMPACT OF DECISIONS

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

 
 

COMMUNICATION/INTERACTIONS

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

 
 

CUSTOMER RELATIONSHIPS

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

 
 

WORKING/ENVIRONMENTAL CONDITIONS

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

 
 

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

Job ID: 122047

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

JOB SUMMARY:

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

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

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

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

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

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

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

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

 
 

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

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

Clipped from: https://www.themuse.com/jobs/hcsc/medicaid-operations-specialist-7cdbc7?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

This position is responsible for assisting in Texas Medicaid programs’ implementation and coordination for the following day-to-day Medicaid operation functions: federal, state and internal reporting, contractual updates and distribution, analysis of operational services data, data and reporting compliance validation, quality improvement performance, and other areas as identified. This resource is responsible for resolving complex and/or escalated internal or external operational issues as they occur. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, reporting changes, business processes, and system changes to ensure the state requirements of the plan are met.

Responsibilities

Required Job Qualifications:

 

• Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
  
• Experience in project development, implementation and execution skills
  
• Experience interfacing with internal clients, operations personnel
  
• Verbal and written communication skills and ability to represent Medicaid department at committee meetings
  
• Experience with interacting effectively with all levels of internal and external customers
  
• Experience managing multiple projects effectively
  
• Interpersonal, organizational and analytical skills
  
• Organizational and leadership skills
  

Preferred Job Qualifications:

 

• Experience working with Medicaid/CHIP or government programs and services
  
• Experience with managing contract provisions
  
• Experience in Project Management
  
• Experience analyzing and reviewing data to assess trends
  

We encourage people of all backgrounds and experiences to apply.

Even if you don’t think you are a perfect fit, apply anyway – you might have qualifications we haven’t even thought of yet.

#LI-LI1

#LI-Hybrid

#LI-FLEX

*CA

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Clipped from: https://www.glassdoor.com/job-listing/collections-specialist-i-medicaid-remote-revenue-cycle-service-center-JV_IC1144489_KO0,40_KE41,69.htm?jl=1008274062794&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Candidates must live within one of the following states to be eligible for hire; Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, Wyoming

Essential Duties and Responsibilities:

• Ensure accurate and complete account follow-up.
  
• Resolve claim processing issues in a timely manner, evaluating problem claims to the appropriate managerial personnel with the insurance carrier’s organization to quickly resolve delinquent claims or contacting patient or third party payers in compliance with established policies and procedures.
  
• Review assigned claims working within the established productivity standards, for timely follow-up maintaining and updating all patient accounts to reflect current information.
  
• Assess each account for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests, making any necessary adjustments, documenting appropriately and submits corrections or request for processing in a timely manner.
  
• Resolve claim processing issues on a timely basis by reviewing claim inventories, payments and adjustments and taking appropriate actions to ensure proper discounts and allowances have been completes as well as identifies account for secondary billing and processes of refers to appropriate personnel.
  
• Document all activity taken on an account in the patient account notes.
  
• Work any assigned correspondence related to assigned accounts.
  
• Perform other required duties in a timely, professional, and accurate manner.
  

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge/Abilities:

• Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written.
  
• Strong telephone communications skills are required.
  
• Carrier-specific reimbursement as applicable to claim processing to include
  

 
 

• benefits and coverage according to specific carrier,
  
• UB 04 claims form preparation
  
• 1500 claims form preparation
  
• Ability to prioritize work and meet deadlines is required. Knowledge of general office procedures is required.
  
• Ability to operate common computer systems, utilize hospital collection system and business software is required.
  

Computer Skills:

Required

• Intermediate knowledge of Microsoft Office Tools (Outlook, Excel, Word and PowerPoint)
  
• Proficiency in hospital patient accounting and billing systems.
  

Preferred

• ArtivaIn
  
• HMS
  

Education/Experience:

• Required High School Graduate or GED equivalent
  
• 1 Year Medical collections experience
  
• Minimum 1 year experience in a hospital business office department
  

Clipped from: https://jobs.communityhealthchoice.org/senior-manager-ncqa-accreditation/job/22807968?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members’ experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

The Sr. Manager of NCQA Health Plan Accreditation plays a key role in Community Health Choice.  Individual & Family Plan (IFP) clinical organization. This leader is accountable for overseeing and actively supporting the development, implementation, and management of NCQA health plan accreditation. They are responsible for annual and as-needed review of accreditation-related policies and procedures. This individual will be relied upon for presentations of accreditation materials to applicable committees. The Sr. Manager of NCQA Accreditation will identify areas of opportunity and collaborate with leadership to remediate risk.

QUALIFICATIONS:

• Bachelor’s Degree in clinical or health care field required.
  
• Master’s degree in a health care related field or business strongly preferred.
  
• Five years progressively responsible management experience in a health care environment.
  
• Three  years experience in a lead position with NCQA accreditation required.
  
• Five years of with NCQA accreditation preferred.
  

OTHER SKILLS:

•  Demonstrated leadership experience specific to a Health Plan Accreditation process.
  
•  Excellent communication skills.
  
•  Ability to facilitate projects across organization and ensure timely delivery of required documents.
  
•  Proficient in annotating and uploading documents to the NCQA portal required.
  

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Note: Current Community Health Choice employees must log in to PeopleSoft via CITRIX to explore career opportunities as an internal candidate. Click HERE for instructions.

Apply Online

Clipped from: https://careers.elevancehealth.com/jobs/jr46871/finance-director-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location:

• VA, Norfolk
  
• Georgia, Atlanta
  
• Wisconsin, Waukesha
  

Description

The Finance Director is responsible for supporting budgeting, forecasting, long-term planning, business strategic analysis of the team, month-end reporting, and corporate deliverables for Medicaid. Provides financial leadership, decision support and strategic direction to support the senior management team’s achievement of the business plan.

Primary duties may include, but are not limited to:

• Provides decision support/analysis and financial leadership to business unit President and senior management team.
  
• Conducts analysis and reporting to understand trends, variances and identify opportunities for margin and operational improvement.
  
• Leads the preparation of budget and forecasts that represent the best projection of future performance.
  
• Works with management to determine assumptions and identify new initiatives for the business unit.
  
• Ensures alignment of budget/forecast to business plan.
  

Minimum Requirements:

• Requires a BA/BS in accounting or finance and a minimum of 5 years of progressively more responsible experience in a high-level financial analysis position for a publicly held company; or any combination of education and experience, which would provide an equivalent background.
  

Preferred Skills, Capabilities, and Experience:

• MBA, CPA, CFM, or CMA preferred. 
  
• Experience supporting senior management and prior leadership experience preferred.
  
• Experience in Medicaid
  
• Hight proficiency in MS Office (Excel, PowerPoint, and Word)
  
• Strong analytical skills
  
• Strong communication skills (verbal and written)
  
• Knowledge of accounting principals
  

 
 

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.ElevanceHealth.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.

Clipped from: https://www.careerbuilder.com/job/J3Q5XX645G6FVJRBMW5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

**Job Family** **:**

Strategy & Transformation Consulting

**Travel Required** **:**

None

**Clearance Required** **:**

Ability to Obtain Public Trust

**What You Will Do** **:**

Guidehouse is seeking a highly motivated, passionate, and detail-oriented Medicaid Data Analytic Coach to support the analysis of State Medicaid data. The ideal candidate will have a strong client service background, acute attention to detail, experience with Medicaid data and analytic tools (e.g., Python, PySpark, R, RStudio) and AWS cloud data architecture.

**Job Description/Responsibilities:**

+ Collaborates with cross-functional team using data analytics, validation, computational checks, cleansing and standardization processing to identify data quality issues, find root causes, and identify solutions.

+ Utilizes analytical, statistical, and programming skills to collect, analyze, and interpret large data sets.

+ Develops custom data models and algorithms to apply to data sets and determines causes of failed data quality checks.

+ Evaluates the effectiveness and accuracy of new data sources and data gathering techniques.

+ Uses predictive modeling to increase and optimize user experiences, system capabilities, and other business outcomes.

+ Documents analyses, creating summaries and presenting written and verbal results to various stakeholders.

+ Applies subject matter expertise relative to Medicaid data (eligibility, managed care, claims, encounters, financial, etc.) to coach stakeholders on data compliance.

+ Maintains, tracks, and collaborates on multiple distinct user community issues simultaneously; keeping all conversations well documented and ensuring appropriate internal/intra team communications to remediate issues or questions.

+ Develops training materials to conduct coaching sessions.

+ Provides data coaching and technical assistance to State Medicaid representatives to resolve data issues, including working sessions to enable a deeper understanding of requirements.

+ Communicate complex data engineering issues/recommendations to all aspects of users, peers, technical and non-technical community, and internal team members.

+ Participates in continuous improvement activities to improve community satisfaction; collaborates with HCD team, Support Analysts, and Engineers.

**What You Will Need** **:**

+ Minimum of eight (8) years of experience.

+ A Bachelor’s degree in Computer Science, Information Systems, Engineering, Math, or other related scientific or technical discipline.

+ CMS or Health Care Industry experience.

+ Experience with Python, PySpark, R, RStudio.

+ Experience in AWS cloud data architecture and big data technologies, including EMR, Databricks, Hive, Spark, AWS Glue, Athena, and Redshift.

+ Ability to communicate technical outcomes with a high degree of detail and precision to technical audiences, while at the same time being able to communicate those outcomes to non-technical audiences in an approachable and understandable manner.

+ Exceptional problem-solving abilities, accuracy with work, strong organizational skills, attention to detail and the ability to multi-task while meeting deadlines.

+ Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.

**What Would Be Nice To Have** **:**

+ Medicaid Data subject matter expertise.

+ Data platform certifications (e.g., Databricks), Coding Certifications (Python, R, etc.) and/or AWS Cloud Certifications.

+ An agile methodologies and iterative mindset; focused on consumer-oriented solutions and communications.

+ Experience applying human centered-design principles during discovery and analysis.

+ Experience with Atlassian Jira/Confluence.

The annual salary range for this position is $86,100.00-$172,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

**What We Offer** **:**

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

+ Medical, Rx, Dental & Vision Insurance

+ Personal and Family Sick Time & Company Paid Holidays

+ Position may be eligible for a discretionary variable incentive bonus

+ Parental Leave and Adoption Assistance

+ 401(k) Retirement Plan

+ Basic Life & Supplemental Life

+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

+ Short-Term & Long-Term Disability

+ Student Loan PayDown

+ Tuition Reimbursement, Personal Development & Learning Opportunities

+ Skills Development & Certifications

+ Employee Referral Program

+ Corporate Sponsored Events & Community Outreach

+ Emergency Back-Up Childcare Program

+ Mobility Stipend

**About Guidehouse**

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at

1-571-633-1711

or via email at [ Email address blocked ] – Click here to apply to Medicaid Data Analytic Coach – Senior Consultant . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

_Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee._

Recommended Skills

• Economics
  
• Corporate Finance
  
• Investments
  
• Financial Accounting
  
• Underwriting
  
• Banking
  

Clipped from: https://www.ziprecruiter.com/c/A-Line-Staffing-Solutions/Job/Social-Worker-Medicaid-Waiver-Coordinator/-in-Columbus,OH?jid=224dbd2aaee9e78d&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Remote Medicaid Waiver Service / Incident Coordinator openings with a Major Health Plan / Managed Care Company based in the state of Ohio! Starting ASAP!! Apply now with Silvana M. at A-Line!

Remote but Must live in Ohio (anywhere in Ohio welcomed)

Hours: 8AM-5PM EST No OT
Pay Rate: $20 – $28 hourly (determined on experience / licensure)

Job Summary:

• Review both critical and reportable incidents submitted for MyCare Waiver members, MyCare Specialized Recovery members and critical incidents for Medicaid members; These incidents will then be placed into Ohio’s Incident Management System; The individual will either substantiate or unsubstantiate reportable incidents on the MyCare side and all critical incidents on the Medicaid side.
  
• Review member’s TruCare chart, and any medical records available; contact member, family members, providers and appropriate community agencies as needed.
  
• Work with the care management team for submission of prevention plans, HSAP’s and any pertinent information.
  
• Work with Ohio’s assigned vendor, PCG (Public Consulting Group) and provide needed information as requested for MyCare’s critical incidents.
  

Performance Expectations/Metrics:

• Employee is expected to submit incidents and ensure that these are followed through and closed within the time period given in MyCare’s 3-way contract CMS and Ohio Department of Medicaid and Medicaid’s contract with the state of Ohio
  

What previous job titles or background work will in this role?

• Waiver Service Coordinator, LPN or social worker with knowledge of Ohio’s MyCare, investigator
  

Required Skills/Experience:

• Knowledge of Ohio MyCare Waiver
  
• Education/License Requirement: LPN, BSW, MSW, or LPC
  
• Basic computer skills with ability to maneuver efficiently through programs
  
• Efficiency with Microsoft and ability to move through programs
  

Preferred Skills/ Experience:

• Incident reporting
  
• Working with multiple programs concurrently
  

Why Apply with A-Line?

• Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  
• 401k after 1 year of employment: With employer match and profit sharing
  
• GREAT Hours! Monday through Friday, 40 hours per week
  
• Competitive Pay Rate!
  

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Clipped from: https://www.linkedin.com/jobs/view/director-of-regulatory-affairs-medicaid-at-cvs-health-3424957794/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

Aetna Better Health of Michigan is seeking a Director,

Regulatory Affairs for its managed Medicaid

business. This role is critical to ensure performance

management and oversight of all requirements of our State of Michigan Medicaid contract. This role will serve as the Medicaid Liaison for ABH-MI with its state customer and assist the Plan COO in the successful growth and performance of the plan. The role interfaces, collaborates, and works cooperatively with functional leaders and centralized shared services business departments on regulatory

matters.

 
 

You will report to the Plan Chief Operating Officer.

 
 

Pay Range

The typical pay range for this role is:

Minimum: 100,000

Maximum: 227,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

 
 

Required Qualifications

• 7-10+ years of work experience that reflects a proven track record and knowledge of State of MI MDHHS regulations, processes, government programs such as

Medicaid, including government affairs, legal, and an in-depth compliance/health plan operations background.

• Experience providing regulatory expertise and guidance

based on state contractual requirements.

• Provide performance management and adherence to

state contract requirements.

• Knowledgeable of the State of MI regulatory processes

• The individual must have recent and related managed

health care experience.

• Experience working collaboratively across many teams,

prioritizing demands from those teams, synthesize

information received, and generate meaningful conclusions

• Strong knowledge of payer systems and configuration a plus.

•Resident of the State of Michigan

 
 

Preferred Qualifications

• Knowledge of the State of Michigan’s legislative

processes and healthcare-related priorities

• Previous payer systems, benefit configuration and health plan operations knowledge preferred.

 
 

Education

Bachelors Degree or equivalent work experience