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Senior Proposal Writer – Medicaid Industry – Remote!

 
 

Senior Writer – Medicaid Proposal Development – Remote Job!

Available: February 2021

 
 

The Senior Writer will join a multi-billion dollar managed care provider of Medicaid in a fully remote position. The Writer will work with Corporate Development and Proposal teams to write responses, meet needs of government customers, develop RFP sections, and write proposals to win Medicaid contracts with state governments. Candidates must have Medicaid proposal writing experience. 3+ years will be considered.

 
 

Responsibilities:

  • Serve as a section lead and providing guidance to other writers assigned to the section to guide response strategy, development, and quality.

*

  • Review other writers’ responses for quality, consistency, voice, and compliance.
  • Review and interpret RFP information including statements of work (SOW) and submission requirements
  • Identify and gather content and information from multiple sources, including past proposal submissions, policies & procedures, other organizational materials, and assisting in market research and competitive analysis activities, as needed.
  • Prepare and conduct interviews with internal stakeholders, consultants, and subject matter experts (SME) to confirm response approach and obtain content
  • Suggest features, benefits, and value propositions to be included in assigned responses and assist in resolving content gaps.
  • Develop narrative responses that are compliant and customer-focused, incorporate appropriate SOW elements, contract requirements
  • Manage assigned sections to ensure information is collected from SMEs and assimilated into drafts in accordance with established deadlines
  • Support the final production of RFP/RFI-response documents

 
 

Requirements:

  • Bachelors degree in English, Communications, or Healthcare Administration
  • 3+ years of proposal writing experience
  • Medicaid proposal experience is a MUST

 
 

Compensation will range to $110,000 + 15% annual bonus and 25 days of PTO

Clipped from: https://www.linkedin.com/jobs/view/senior-proposal-writer-medicaid-industry-remote%21-at-firstpro-inc-2389509672/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Certified Recovery Peer Specialist – Remote in Pasco or Pinellas County, Florida – Molina Healthcare

 
 

Molina Healthcare

**Job ID** 2006541


We are seeking a Certified Recovery Peer Specialist (CRPS) who will work remotely but lives in either Pasco County or Pinellas County, Florida.


**Knowledge/Skills/Abilities**


+ Provides peer support services for members with behavioral health issues, psychiatric disorders, drug and/or alcohol dependence, and physical illnesses.


+ Serves as a consumer advocate by providing consumer information, resources and peer support for clients in outpatient and inpatient settings.


+ Assists members in setting and pursuing their own recovery goals and in working with their case managers and/or treatment team to determine the steps needed to achieve these goals.


**Job Qualifications**


**Required Education**


High School diploma or GED.


**Required Experience**


+ Managed Care exposure and knowledge of community resources


+ Knowledge of HIPAA and confidentiality rules


**Required License, Certification, Association**


+ Certified Recovery Peer Specialist (CRPS) in Florida


+ Valid State Driver’s License with proof of insurance.


**Preferred Education**


Graduate of a two or four year allied Health Program.


**Preferred Experience**


Experience in psychiatric unit or facility a plus.


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.


**About Us**


Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.


**Job Type:** Full Time


**Posting Date:** 01/22/2021

 
 

Clipped from: https://www.zippia.com/new-port-richey-fl-jobs/recovery-specialist-dlp/?a20900a8891bb001ba001037657acac9de2582cd&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Project Manager – Medicaid – Omega Solutions Inc – Columbia, SC

 
 

Medicaid, PM, PMP Certification

Full Time

Depends on Experience

Job Description

Job Title: Project Manager  – Medicaid 
Work Location:  Columbia, SC        

Desired Start Date: 1/25/2021

Duration: 6+ Months

Hours per week: 40 hrs

 
 

DAILY DUTIES / RESPONSIBILITIES:
DDSN is seeking a Project Manager for 6 Months engagement to be responsible for handling our IT related projects. You will be working closely with the IT team members, the operations and finance team to ensure that all IT project requirements, deadlines, and schedules are on track. Responsibilities include submitting project deliverables, preparing status reports, and establishing effective project communication plans as well as the proper execution of said plans. To be a successful candidate, you will need to have proven experience in project management and the ability to lead project teams of various sizes. A Project Management Professional (PMP) certification is strongly desired.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Coordinating with cross discipline team members to make sure that all parties are on track with project requirements, deadlines, and schedules.
• Meeting with project team members to identify and resolve issues.
• Submitting project deliverables and ensuring that they adhere to quality standards.
• Preparing status reports by gathering, analyzing and summarizing relevant information.
• Establishing effective project communication plans and ensuring their execution.
• Managing customer satisfaction within project transition period.
• Conducting post project evaluation and identifying successful and unsuccessful project elements.
• Medicaid experience
• Medicaid Management Information Systems
• Financial Accounting
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
1. Facilitating change requests to ensure that all parties are informed of the impacts on schedule and budget.
2. Coordinating the development of user manuals, training materials and other documents as needed to enable successful implementation and turnover of the process or system to the clients.
3. Obtaining customer acceptance of project deliverables.

REQUIRED EDUCATION:

BS IN IT OR RELATED FIELD
REQUIRED CERTIFICATIONS:
PMP CERTIFICATION

 
 

Dice Id : 10289500

Position Id : 6817849

Originally Posted : 5 days ago

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Project Manager – Medicaid

Omega Solutions Inc

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Clipped from: https://www.dice.com/jobs/detail/Project-Manager-%26%2345-Medicaid-Omega-Solutions-Inc-Columbia-SC-29201/10289500/6817849?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Senior Manager of Medicaid Analytics (Work At Home) – Apply Today Now – Bedford, TX, USA – Bedford

 
 

  • Full Time
  • Part Time
  • Bedford,TX
  • Posted 4 months ago

Company Details

Bedford

**Overview** **:****This role is an opportunity to build a Data & Analytics team supporting Cigna’s Medicaid business from the ground up. The Medicaid business needs the right leader to build a mature data platform and analytics capability to enable growth. The Medicaid Data & Analytics Lead will translate the Medicaid business’s strategic objectives into a roadmap of tools and capabilities that will use data to help make better business decisions and deliver more personalized business insights. The candidate will assemble a team of data experts and business analytics professionals to deliver a broad portfolio of projects, spanning foundational data capabilities, reporting, analytical tools, population health, and customer insights. They will engage in a collaborative, cross-functional group spanning senior leadership and a variety of functional areas (e.g. operations, clinical management, finance, medical economics, and network).****The right leader will possess a strong degree of creativity, innovation, business and financial acumen, leadership ability, and a core data/analytics skillset. They will also demonstrate a talent for translating between technical and non-technical audiences, as well as a desire to champion a data-driven culture with our business partners.****Responsibilities:****Create a detailed roadmap of new capabilities and timing needed to develop a mature Medicaid analytics function** **Develop a strong perspective on the Medicaid business’s strategic goals** **Build relationships with Medicaid senior leadership and key stakeholders** **Understand the current state of Medicaid data and reporting and the existing gaps for all stakeholders** **Create a project plan to document the proposed approach to closing gaps and meeting stakeholder needs****Build a small team from the ground up to execute on the roadmap** **Lead recruitment for a talented team of data, analytics, and reporting professionals** **Set high standards for talent acquisition to attract a high-caliber team with a balance of skill-sets** **Create a team culture of success, innovation, and ethics****Create a strong data foundation for analytics, in partnership with IT organization** **Develop data views, including internal and external sources, to support automated reporting and more sophisticated analytics** **Document and work to automate existing manual data and reporting processes****Identify and recommend operational, clinical, and network trends and opportunities** **Align with state value-based programs and reporting** **Prepare population health analytics by cohorts or acuity levels** **Identify of data anomalies in network and clinical trends for action** **Support Medicaid business with proactive business analytics that align with state contracts****Lead the development of a management scorecard and a suite of reports to allow business leaders to assess and diagnose key trends** **Build automated reporting on financial performance, medical cost trend, clinical management, and other areas** **Provide insights and commentary on drivers of results****Prioritize and execute on the creation of new analytical tools to provide deeper, more granular insights on customer behavior, provider performance, clinical program outcomes, and other business drivers.** **Consider a variety of analytical techniques to meet business need (e.g. financial models, matched-case control studies, machine learning, etc.)** **Provide ad hoc analysis and insight as needed****Operate in a highly ethical and compliant manner, with attention to the unique regulatory demands of the Medicaid business****Qualifications:****Bachelor’s degree or higher in a quantitative field (statistics, mathematics, computer science, finance, actuarial science, data science, business analytics, or equivalent training)****7+ years of work experience, including experience with health care data and statistical analysis****Prior Medicaid business expertise strongly preferred, particularly with prior work in clinical, network, and/or operations functions****Strong expertise working with complex databases, including advanced SQL skills****Strong business and financial acumen, including knowledge of health insurance financial drivers****Strong customer focus, communication, and management of business partner expectations****Ability to think creatively and put structure around complex problems****Ability to translate business needs into practical applications and solutions****Ability to clearly present findings to a diverse group of teams with varying levels of technical expertise****Prior managerial experience strongly preferred****Location is flexible, including WAH option****About Cigna**Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram._Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.__If you require reasonable accommodation in completing the online application process, please email: …@cigna.com for support. Do not email …@cigna.com for an update on your application or to provide your resume as you will not receive a response._

 
 

Clipped from: https://www.applytodaynow.site/job/senior-manager-of-medicaid-analytics-work-at-home/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Call Center Agent – Medicaid/healthcare Job in Cheyenne, WY at HHS Technology Group

 
 

HHS Technology Group Cheyenne, WY

HHS Technology Group is a valued and trusted systems integration partner for several departments within a number of State Governments.  The intense growth and tremendous financial forecast we are experiencing at HHS Technology Group can largely be attributed to our successes on these initiatives and having strong performance accelerating state government technical solutions.

Responsibilities:

  • Identify customers’ needs, clarify information, and provide solutions and/or alternatives
  • Managing large amounts of inbound calls and making outbound calls to follow-up on previous inquiries related to Medicaid provider enrollments
  • Keep records of all conversations and engagements in the call center database
  • Build sustainable relationships and engage customers
  • Screening, tracking, and processing incoming Medicaid provider enrollments

 
 

  • Performing provider file updates and file maintenance
  • Prepare and respond to audit requests
  • Communicating directly with other call center personnel, internal departments, providers, auditors, supervisors, and stakeholders with Medicaid and State Agencies
  • Conducts enrollment and update training
  • Meet quality controls and production standards
  • Occasionally attend training seminars to improve knowledge and performance level

 
 

Minimum Requirements:

  • At least 1 year of previous experience in a customer service or support role handling inbound and/or outbound phone calls as well as email inquiries
  • Prior experience handling Medicaid related calls
  • Ability to work in our Call Center, with remote work allowed during the COVID-19 pandemic
  • Ability to effectively use all available resources to provide the right response or direction quickly
  • Skill in writing concise, grammatically correct correspondence and notes, with strong typing and writing skills for clear communication
  • Familiarity with CRM systems and practices
  • Demonstrated ability to adhere to polices and procedures with flexibility and adaptability
  • Customer focus, attention to detail, and the ability to adapt to different personality types
  • Ability to multi-task, set priorities, and manage time effectively enough to maintain set performance expectations
  • Ability to learn new processes, procedures, software programs and systems quickly
  • Ability to work independently as well as in a team environment within an office setting
  • Ability to demonstrate proficiency in the use of the MS Office Suite and navigation within the most recent versions of the Windows Operating System
  • Understanding of standard HIPAA protocols
  • High School Degree

 
 

Preferred Requirements:

  • 2+ years of previous experience in a customer service or support role handling inbound and/or outbound phone calls as well as email inquiries
  • Experience screening, tracking, and processing Medicaid provider enrollments
  • Prior experience working in a Healthcare setting and/or Medicaid State Agencies
  • Experience in conducting training remotely
  • College Degree

HHS Tech Group employees enjoy a very comprehensive and competitive benefit package:
•    Fully paid dental, vision, life insurance, and disability insurance. 
•    Generous 401k matching program fully vested from beginning.
•    Generously sponsored Medical Insurance through Cigna (PPO or HSA – with company match)

 
 

 Clipped from: https://www.ziprecruiter.com/c/HHS-Technology-Group/Job/Call-Center-Agent-Medicaid-healthcare/-in-Cheyenne,WY?jid=9aaeae4f9c159871&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Catapult Consultants, LLC Medicaid Reviewer I Job in Omaha, NE | Glassdoor

 
 

Catapult Consultants LLC is seeking a Medicaid Reviewer I to work on a federal government project, the Payment Error Rate Measurement Review Contractor (PERM RC), for the Centers for Medicare & Medicaid Services (CMS). The Medicaid Reviewer I will be responsible for the review of all Medicaid-related policies, including state and federal policies, rules, and regulations; advising PERM data processing and review staff on interpretation of policy; and discussing the effect of policy on review findings. This individual will conduct data processing reviews on each sampled FFS and managed care payment to validate that the claim was processed correctly based on information found in the state’s claim processing system and other supporting documentation maintained by the state. This work may be applicable for Medicaid and CHIP claims processed in all 50 states and the District of Columbia.

This role is Full-Time with full benefits. The work will be performed primarily while on travel to Medicaid state locations (50-70%) and while working at home (30-50%). Travel will be scheduled for 2 weeks at a time to fly out on Sunday and work through at least Noon on the second Friday. Travel will be to IL, VA, WI, NM, MN, WY, KS & PA.


Specific Responsibilities:

 

  • Initiate, support, monitor and evaluate medical review activities related to the PERM task order, including compliance with contract deliverables, internal and external performance requirements, and continual improvement.
  • Provide support to the Data Processing Review Management staff and Operations area. Complete Data Processing reviews in accordance with internal and CMS metrics/timeliness requirements. Communicate and collaborate process improvements identified to the Data Processing management team to ensure we continually meet and exceed expectations.
  • Audit Medicaid FFS, Medicaid CHIP and managed care claims. Review and analyze multiple claim processing, eligibility enrollment, and provider enrollment systems. Make an informed decision to determine if the information in all systems resulted in an accurate payment determination.
  • Collaborate with Senior Reviewers and Leads about how state and federal policies and regulations are applied to specific claim scenarios in front of stakeholder staff. Collaborate directly with stakeholder staff and the customer about complex review scenarios and how state and federal regulations are applied.
  • Consult with Senior Reviewers and Leads about the implication of how state and federal policies and regulations are applied in differing claims scenarios.

Minimum Qualifications:
 

  • Bachelor’s degree or equivalent work experience.
  • At least 2 years’ experience with Medicaid/CHIP data (specify which states on resume and cover letter).
  • Extensive knowledge of medical terminology and coding principles.
  • Ability to read insurance claims, both paper and electronic, and a basic knowledge of the insurance claims systems.
  • Ability to read and understand complex Medicaid policies.
  • Knowledge of, and the ability to correctly identify, insurance coverage guidelines.
  • Familiarity with CPT codes, ICD-10-CM codes, and HCPCS codes.
  • Strong critical thinking and decision making capability.
  • Knowledge of and ability to use Microsoft Word, Excel and Internet applications.
  • Ability to quickly adapt and thrive in a changing work environment.
  • Must have no adverse actions pending or taken by any State or Federal licensing board or program.
  • Must live within reasonable commuting distance of a major airport.
  • Must have and maintain a valid driver’s license for state of residence.

• Fingerprint background check may be required.

 
 

 
 

Abilities Required:

 
 

  • While performing the duties of this job the employee is regularly required to sit and use hands to finger, handle, or feel while typing at a computer keyboard.

 
 

  • The employee is occasionally required to stand, walk, reach, or lift objects up to 10 pounds.

 
 

  • The employee is frequently required to talk or hear. The vision requirements include: close vision.

 
 

EEO Statement

 
 

Catapult Consultants is an Equal Opportunity Employer. We believe that every employee has the right to work in a dignified work environment free from all forms of discrimination and harassment. It’s our policy to recruit, employ, retain, compensate, train, promote, discipline, terminate and otherwise treat all employees and job applicants based solely on qualifications, performance, and competence. This policy reflects our belief that providing equal opportunities for all employees is a both our legal and moral responsibility, and good management practice.

All employees and applicants are treated without regard to age, sex, color, religion, race, national origin, citizenship, veteran status, current or future military status, sexual orientation, gender identification, marital or familial status, disability or any other status protected by law.

 

 
 

Disclaimer

 
 

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Clipped from: https://www.glassdoor.com/job-listing/medicaid-reviewer-i-catapult-consultants-JV_IC1136440_KO0,19_KE20,40.htm?jl=3667593988&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Attorney III, Criminal, Medicaid Investigations at State of North Carolina – Tarta.ai

 
 

Description of Work

THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF  $ 84,728 to $ 90,799. 
Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.


The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the State of North Carolina in court and provides legal advice and representation to most state government departments, agencies, officers, and commissions. The Department also represents the State in criminal appeals from state trial courts, and brings legal actions on behalf of the state and its citizens when the public interest is at stake.


This position is not-subject to the Fair Labor Standards Act.


This position is located in the Medicaid Investigations Division of the Department of Justice.  The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees.  These cases also protect our most vulnerable elderly and disabled citizens.

 

The Medicaid Investigations Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,348,028 for Federal fiscal year (FY) 2021. The remaining 25 percent, totaling $2,116,008 for FY 2021, is funded by the State of North Carolina.

 
 

Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff.  MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations.  Cases are tried in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC SBI, Sheriffs’ Offices, and Police Departments.

Over the past decade, the NC MID has recovered more than $20 million per year for the past three years and helped win more than 450 criminal convictions in health care fraud and abuse cases.


The Attorney General’s office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.

https://www.ncdoj.gov/Top-Issues/Stop-Health-Fraud-(1).aspx

The Criminal Section conducts investigations and brings state and federal actions against Medicaid providers alleged to have committed complex health care fraud schemes.

 

The primary purpose of the Criminal Enforcement Attorney position is to prosecute criminal cases and assist with criminal investigations. The criminal cases involve Medicaid fraud, patient abuse, and/or misappropriation of patient funds. The Criminal Section will bring state and federal actions against Medicaid providers alleged to have committed complex health care fraud schemes. The Criminal Enforcement Attorney position is also one of the attorney positions that fulfills the staff requirements of a MFCU contained in Title 42 of the Code of Federal Regulations, Section 1007.13(a)(1), which mandates that the MFCU staff must include “one or more attorneys experienced in the investigation or prosecution of civil fraud or criminal cases, who are capable of giving informed advice in applicable law and procedures and providing effective prosecution or liaison with other prosecutors.”

The allegations investigated include the submission of fraudulent claims to the Medicaid Program for services or supplies not rendered, billing for a higher level of service than was actually provided, double billing, soliciting or paying kickbacks, billing for a service the provider knows is not medically necessary, and cost report fraud. Allegations investigated also include patient abuse and neglect and the misappropriation of patient funds.


Duties include:

 
 

  • Thoroughly review all pertinent information relating to cases referred to the Division or generated by the Division.
  • Ensure investigations are conducted within the parameters and in accordance with current state and federal laws and court rulings which are often complicated and technical in nature.
  • Determine whether there is a criminal violation of the law by thorough and precise analysis, research of documentary evidence, and interviews.
  • Analyze, review and prepare state and federal arrest warrants, indictments, and other pleadings necessary to the successful prosecution of charges initiated by the Division.
  • Supervise the preparation of cases being presented in state or federal court.
  • Work with investigators to investigate cases and gather sufficient evidence to support the filing of a state or federal indictment or warrant,
  • Prepare discovery and analyze and respond to discovery requests, and ensure that all discovery is provided as required by law.
  • Perform legal research in the field of health care fraud and investigations including precedent setting arguments.
  • Organize trial documents to insure their admissibility and to make them understandable to the court and jury.
  • Pursue cases in state court as a Special Prosecutor or in federal court as a SAUSA or may pursue the case jointly in state or federal court with Assistant District Attorneys or Assistant United States Attorneys.
  • Negotiate criminal pleas in complex criminal actions, prepare agreements for criminal restitution, and analyze financial settlements proposed by opposing counsel.
  • Pursue and assist in the recovery of damages and penalties from Medicaid providers who have committed fraud by bringing and supporting state and federal forfeiture proceedings.
  • Lead parallel criminal actions and provide direction to the investigators on the criminal aspects of the matter.
  • Provide consultation and advice to the Criminal Chief and Director; keep the Director and Criminal Chief apprised of important developments in criminal cases.

This position requires travel which may include overnight stays.
This position requires some overtime.

Knowledge, Skills and Abilities / Competencies

  • Ability to effectively bring and supervise complex investigations of fraud by providers of medical assistance under the state Medicaid Program and other health care programs.
  • Thorough knowledge of laws and regulations pertaining to health care, particularly those relating to the Medicaid program.
  • Thorough knowledge of rules and regulations pertaining to Medicaid reimbursement and considerable knowledge of the administrative operation of health care facilities and professional medical offices and the ability to deal effectively with management and employees of these organizations.
  • Working knowledge of the federal and state criminal laws relating to fraud by health care providers.
  • Thorough knowledge of accounting and auditing principles and practices.
  • Thorough knowledge of the legal principles and techniques of conducting criminal investigations.
  • Thorough knowledge of state and federal forfeiture actions.
  • Ability to examine and analyze all types of medical and business records, and present the findings to courts and juries orally and in writing to reveal in a clear and orderly manner and the legal position of the Division in the interpretation of complex statutes and regulations.
  • Working knowledge of criminal health care fraud and the ability to recognize matters initially referred to the Division for civil action that should be investigated to determine whether a criminal health care fraud offense has been committed.
  • Ability to communicate effectively on medical and financial matters before a court and jury,
  • Ability to effectively utilize and direct medical consultants in reviews of the practices of medical providers,
  • Ability to maintain an effective working relationship with judges, related federal and state agencies and administrators, and other legal and administrative staff within the Department of Justice, and the general public.
  • Able to satisfactorily complete a detailed federal agency national security personal background investigation in order to become eligible for appointment as a SAUSA.

Minimum Education and Experience Requirements

Licensed to practice law by the North Carolina State Bar and three years of progressively responsible professional legal experience. NOTE: GS 114-2 and 114-6 make it the duty of the Attorney General of NC to represent the State of North Carolina in all litigation unless another statute specifically states otherwise.

Supplemental and Contact Information

Computer literacy is an important component of all DOJ jobs, we encourage you to apply electronically. All applicants must complete and submit a State application for employment using the NEOGOV Online Job Application System (http://www.oshr.nc.gov/jobs/) for the State of North Carolina.

To receive credit for your work history and credentials, you must list the information on the online application form. Any information not included on the application form cannot be considered for qualifying credit. Embedded or attached resumes are not accepted as a substitution for a completed application.


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DSNP Member Advocate – Work At Home (New Haven) | New Haven, CT | CVS Health

New Haven, CTWork from home

  • Job DescriptionThis position will act as part of the dual eligible member’s care team at the state level responsible for integrating and coordinating care to meet the uniquely complex healthcare needs of our DSNP members.
  • This position will assist our dually eligible members with maintaining Medicaid and LIS eligibility and obtaining other Medicaid entitlements available to them.
  • They will be responsible for monitoring member statuses and reporting results to management.
  • Work alongside other DSNP care team members including social workers, care managers and care coordinators to provide the be member experience by: Educating and assisting members on various elements of Medicaid entitlements, benefit plan information and available services created to enhance the overall member experience with the company.
  • Utilize all relevant information to effectively influence member engagement.
  • Initiating contact with members who have lost Medicaid eligibility and fall into DSNP grace period to obtain Medicaid and LIS certification.
  • Assist members with finding resources to help them reapply if necessary.
  • Coordinating annual reminders for members at risk of losing LIS, Medicaid or DSNP eligibility.
  • Taking ownership of each customer contact to anticipate customer needs, resolve their issues and connect them with additional services as appropriate.
  • Identifying member needs beyond the initial inquiry by answering the unasked questions and asking probing questions to identify member needs.
  • Other responsibilities include:Track member’s Medicaid certification and eligibility dates and MCO plan information, as well as Medicaid status.
  • Researching other Medicaid programs and entitlements the members are eligible for and initiate process to inform members of these benefits.
  • Complete accurate case documentation as needed.
  • Communicate cases to management where contact has not been achieved.
  • Other general outreach to members as needed.
  • Works with National DSNP Program Office Medicaid Policy Manager and State Contract Manager to provide general assistance with Medicaid benefits and entitlements.
  • Associates degree or equivalent work experienceEmpathy towards customers’ needs and concerns, and proactively solicits and anticipates customer needsIn-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other benefits), related financials, legal/regulatory requirements.
  • Demonstrated experience and knowledge in state policy or Medicaid eligibility and low-income state resources.
  • Strong collaboration skills and innovative problem-solving abilities.
  • Strong verbal and written communication skills.
  • Ability to maintain accuracy and production standards.
  • Ability to work independently.
  • Innovative Thinking and “Change Agent” – Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.
  • Required QualificationsAssociates degree or equivalent work experienceEmpathy towards customers’ needs and concerns, and proactively solicits and anticipates customer needsIn-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other benefits), related financials, legal/regulatory requirements.
  • Preferred QualificationsPlease review required qualifications aboveEducationAssociate’s degree or equivalent experienceBusiness OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health.
  • We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused.
  • Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
  • We are committed to maintaining a diverse and inclusive workplace.
  • CVS Health is an equal opportunity and affirmative action employer.
  • We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.
  • We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 

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CVS Health

 
 

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Medicaid Senior Business Consultant (Telecommute) | Columbia, SC | UnitedHealth Group

 

Columbia, SC Full-timeWork from home

  • Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get.
  • Leading edge technology in an industry that’s improving the lives of millions.
  • Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably.
  • There’s no room for error.
  • Join us and start doingyour life’s best work.
  • (sm)If you are located in South Carolina, you will have the flexibility to telecommuteas you take on some tough challenges.
  • When in a UnitedHealth Group building,employees are required to wear a mask in common areas.
  • In addition, employeesmust comply with any state and local masking ordersPreferred Qualifications:+ Undergraduate degreeCareers with Optum.
  • Here’s the idea.
  • We built an entire organization around one giant objective; make health care work better for everyone.
  • So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve.
  • Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential.
  • For you, that means working on high performance teams against sophisticated challenges that matter.
  • Optum, incredible ideas in one incredible company and a singular opportunity to doyour life’s best work.
  • UnitedHealth Group is a drug-free workplace.
  • Candidates are required to pass adrug test before beginning employment.

Clipped from: UnitedHealth Group

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QA Specialist Medicaid Eligibility jobs in HCA Medicaid Eligibility(RCPS) in United States. | Laimoon.com

Description SHIFT: Work From Home

SCHEDULE: Full-time

Are you looking for a work environment where diversity and inclusion thrive? Submit your application with HCA Healthcare today and find out what it truly means to be a part of a team.

We value your contributions. Our employee recognition programs encourage our teams to raise the bar. Come be a part of the change!


We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity!

What you will do in this role:

  • Perform quality assurance activities for Medicaid eligibility operations to ensure that work efforts satisfactorily meet customer requirements in a systematic, reliable fashion, effectively using systems to do so.
  • Perform analytical assessments of data and assist the management team in using the data for decision-making purposes.
  • Maintain prompt and accurate documentation outlining all steps of the QA program that have been taken in individual organized files. Complete the proper forms. Audit the assigned number of accounts per day following a set schedule. Forms will be completed and submitted within required timelines.
  • Work independently with various departments to ensure revenue is maximized.
  • Maintain reports that are indicative of process improvement within departments while promoting a positive presence in improving these processes.
  • Make recommendations based on assessments that improve production and quality.
  • Ability to multi-task to ensure day-to-day work is complete as well as assigned projects.
  • Coordinate QA findings with appropriate departments, internal or external, and ensure that necessary follow up is done to resolve any negative results.
  • Provide documented results and process improvement to Director for departments not meeting company/client standards.
  • Perform special projects or other activities as assigned. Establish and maintain constructive working relationships with coworkers, supervisors, managers and executives, as well as external clients and other external business contacts.
  • Document progress notes to the patient’s file and the hospital computer system.
  • Participate in ongoing, comprehensive training programs as required.
  • Required to make field visits as necessary.

Qualifications

  • Proficient knowledge of Government Assistance Programs, including Medicaid/Medi-Cal and SSI/SSD and the application process for each to ensure successful conversion of accounts.
  • Familiarity with Medicaid billing and reimbursement processes including retro-certification process desired. Capable of meeting production quotas.
  • Ability to collect, synthesize and research complex or diverse information.
  • Travel requirements <25%
  • Minimum of 3 years preferred experience within Medicaid Eligibility, preferably as both a hospital-based screener and an application processor.
  • Experience with standard suite of Microsoft office software products.
  • Intermediate to advanced proficiency with Excel and Word required.

ABOUT US

Parallon is an industry leader in revenue cycle services. We partner with over 650 hospitals and 2,400 physician practices nation-wide. Our parent company, HCA Healthcare has been consistently named a World’s Most Ethical Company by Ethisphere and is ranked in the Fortune 100. We are dedicated to ensuring our patients have the best experience even after they leave our facilities.

We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability

status.


#ParallonBCOM

Notice Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here. For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

 
 

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