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Medicaid Community Healthcare Outreach Coordinator – Telecommute in Aspen, Glenwood Springs, CO Job in Denver, CO – UnitedHealth Group



Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the UnitedHealthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our Members and partners in the state where we live, work, and play – because we’re Colorado, too.

You push yourself to reach higher and go further. Because for you, it’s all about ensuring a positive outcome for patients. In this role, you’ll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you’ll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients.

In this Medicaid Behavioral Health Outreach Coordinator role, will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs.

If you are located in Aspen / Glenwood Springs CO, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:


  • Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
  • Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
  • Manage the care plan throughout the continuum of care as a single point of contact
  • Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
  • Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
  • Act as a resource to other team members as it relates to behavioral health issues

Expect to spend up to 80% of your time in the field visiting our members in their homes or in long-term care facilities. You’ll need to be flexible, adaptable and, above all, patient in all types of situations

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.


Required Qualifications:

  • Undergraduate Degree or 3+ years of experience working within the community health setting in a health care role (or experience as mandated by the state contract)
  • Reside within a commutable distance of Garfield / Pitken County
  • Experience in case management or care coordination
  • 1+ year of experience in Behavioral Health
  • Experience working with MS Word, Excel and Outlook
  • The ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals or providers’ offices
  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained


Preferred Qualifications:

  • LPN/LVN, CNA, licensed social worker and/or behavioral health or clinical degree
  • A background in managing populations with behavioral health needs
  • Experience with electronic charting
  • Prior field based work experience

Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). For more than 225,000 members of our unique, physician-founded health care organization, we provide innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. As a part of Optum, the fastest growing part of the UnitedHealth Group family of businesses, we’ve enhanced our offerings through sophisticated tools and technologies, superior customer service and a commitment to striving to improve the health and wellness of our Members and partners in the state where we live, work, and play – because we’re Colorado, too. From a career perspective you couldn’t do better. We’re all about quality and making a difference. And can make our opportunities your opportunity to do your life’s best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action 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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords:Medicaid Community Outreach Coordinator. Community Outreach Coordinator, Outreach Coordinator, Behavioral Health, Medicaid, Community health, Case management, Care Coordination, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, Aspen, Glenwood Springs, Colorado, CO


Recommended skills

Community Health

Behavioral Health

Long Term Care

Licensed Practical Nurse

Case Management


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Process Improvement Representative 2 – Medicaid- Remote Job Opening in Tampa, FL at Humana




 Tampa, FL Remote Full Time

Job Posting for Process Improvement Representative 2 – Medicaid- Remote at Humana


The Process Improvement Representative 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.


Where you Come In 

The Process Improvement Representative 2 researches best business practices within and outside the organization to establish benchmark data. Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. Determines how new information technologies can support re-engineering business processes. May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

What Humana Offers 

  • We are fortunate to offer a remote opportunity for this job.  Our Fortune 100 Company values associate engagement & your well-being.  We also provide excellent professional development & continued education.  


Required Qualifications – What it takes to Succeed 

•    Minimum of an Associate’s degree
•    2 years of proficient experience with data analytics and query development
•    Advanced Excel (pivot tables, graphs & charts), PowerPoint, Adobe PDF, Visio, SharePoint
•    Tableau or Qlikview or PowerBI or SQL experience
•    Health Plan experience
•    Experience with ensuring proper controls are established and maintained over test and production systems and software source code
•    Must be passionate about contributing to an organization focused on continuously improving consumer experiences
•    Must be able to work 8:00-5:00 PM EST zone hours

Work At Home Requirements

•    Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work. 
•    Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

Preferred Qualifications
•    Experience in the design and/or development of business/quality systems (processes and procedures) and/or measurement systems
•    Knowledge of software development lifecycle
•    Experience with Root Cause Analysis with large data sets
•    Previous Medicare/Medicaid Experience a plus
•    Experience with job aid development, user training guides and Visio process flow development

Additional Information – How we Value You
•    Benefits starting day 1 of employment 
•    Competitive 401k match  
•    Generous Paid Time Off accrual  
•    Tuition Reimbursement 
•    Parent Leave 
•    Go365 perks for well-being 

Interview Format 

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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 interview. In this interview, you will listen to a set of interview questions over your phone or text 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. 

Additional Information

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

Scheduled Weekly Hours


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Medicaid Project Coodinator at IDR, Inc.

 Medicaid Project Coodinator

IDR, Inc. Job Description

Long-term and 100 Remote opportunity for a Project Coordinator to support a Medicaid State Funded multi-year project. The Project Coordinator will track project schedule costs, KPIrsquos, Earn Value Analysis, and Custom Table for a Medicaid Data Warehouse initiative. Desired Skills 3+ years of experience as a Project Coordinator Project Manager working in MedicaidMedicare, and MMIS projects Expertise in MS Project Experience working on State Funded Projects overseeing the schedule tracking for Project’s Budget and Cost Why IDR? 20+ Years of Proven Industry Experience in 4 major markets Employee Stock Ownership Program (ESOP) Dedicated Engagement Manager who is committed to you and your success Medical, Dental, Vision, and Life Insurance ClearlyRatedrsquos Best of StaffingRegistered Client and Talent Award winner 7 years in a row


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Humana Principal, Clinical Business Development (Medicaid) Job in Remote | Glassdoor


The Market Development Principal provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience.


The Medicaid Behavioral Health Business Development Principal provides support to assigned business development team and/or specialty companies relative to Medicaid mental health and substance abuse business strategy and solutioning, implementation, operations, contract compliance, and federal contract application submissions. The Market Development Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical and Medicaid behavioral experience.


The Medicaid Behavioral Health Business Development Principal serves as the primary resource and SME for business development. Ensures that RFP content and clinical model is meeting or exceeding corporate and state Medicaid requirements. Works with senior executives to develop and drive segment or enterprise-wide functional strategies. Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert competent to work at very high levels in multiple knowledge and functional areas across the enterprise.

Required Qualifications

  • Bachelors Degree
  • Experience in fully integrated physical and behavioral clinical models
  • 10 years working experience in leading mental health and substance abuse Medicaid strategy for complex populations
  • 10 years working experience in leading Medicaid strategy for complex populations
  • 10 or more years of program design, execution and measurement in the Medicaid population
  • 5 years of project/people leadership
  • Experience as subject matter expert in Medicaid RFP process
  • Strategic thinking and planning capabilities
  • Organized and detail-oriented
  • Excellent presentation and communication skills, both internal and external audiences
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Able to effectively work in matrix organization and influence senior leadership level key stakeholders

Preferred Qualifications

  • Graduate Degree
  • Experience evaluating competitor capabilities, determining where there are gaps and making recommendations to close them

Additional Information

•Limited travel

Scheduled Weekly Hours



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Medicaid Care Coordinator (REMOTE) at CRS Group –

Medicaid Care Coordinator (REMOTE)

Duration: 6+ month contract (likely to extend)

Location: Chicago, IL 60601

Pay Rate: $24.45/hr


Overview: The CRS Group is currently looking for a Medicaid Care Coordinator (REMOTE) for one of our clients in the Chicagoland area. The CRS Group is a nationwide Staffing Firm who works primarily with Fortune 500 and Fortune 1000 corporations.


Duties and Responsibilities:

  • This position is responsible for monitoring Medicaid/Medicare and related regulations and policy changes impacting clinical operations
  • Participating in audits
  • Supporting tracking and submission of Medicaid State Contract(s) related deliverables, including fulfillment of internal and contractual reporting requirements
  • Working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicaid program are met
  • Assisting MMP in coordination of the contract with the State/CMS enterprise-wide.


  • Bachelor Degree in Business OR 2 years’ experience with health insurance.
  • 1 year of experience with health insurance benefits and/or operations.
  • Knowledge of Medicaid and Medicare product(s).
  • Verbal and written communication skills.
  • Experience presenting trends and findings in meetings with management.
  • Experience organizing multiple tasks and responsibilities.
  • Experience analyzing data reports.
  • Experience developing and running queries in a database.
  • PC proficiency to include Microsoft Word, Excel, PowerPoint, and Outlook
  • Knowledge of health benefits.
  • Knowledge of Health Plan Clinical Operations.


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CNSI Project Manager (Medicare, Medicaid, or Healthcare verticals) – Remote Position Job in Atlanta, GA

Working remotely within the United States is acceptable for this position.

What you will do:

Oversees one or more software products end-to-end and assists in the direction of particular project-level activity and associated team personnel.
Works under general supervision.
Maintains relationship with client, project scope can increase in complexity and size.
Manages client relationships at the client customer work site.
Provides project management for prime or sub-contractor, fixed price, or time and materials projects.
Provides project management on projects with a team size that is up to 100 employees concurrently.
Provides project management on projects with annual total contract value of up to $50M and complexity (hours) of up to 300,000 hours.
Provides end-to-end responsibility for one or more products, sub-systems or level responsibilities.
Develops detailed, resource loaded project schedule with the required metrics.
Confers with project personnel to provide technical advice and to resolve problems.
Manages project risk by working with project schedulers to track project schedules, deliverables, and milestones; monitors costs and schedules using EVM and other tools.
Oversees and develops a feasible plan for one or more software products that achieves the goals and objectives of the project and aligns with the organization’s overall business strategy.
Assists in developing a feasible plan that achieves the goals and objectives of the project and aligns with the organization’s overall business strategy.
Determines project scope and recommending and assigning resources as available.
Determines estimated time and financial commitment of project, and in monitoring progress.


Implements, maintains, and reports Earned Value (EV) metrics into project plans.
Implements, maintains, and reports CNSI project delivery metrics into project plans.
Assists in monitoring and developing a project budget and tracking actual spend compared to the planned budget, escalating to senior leadership as needed.


Partners with customers and analyzes issues and problems from the customer perspective.
Provides customer-facing presentations on quality.
Communicates and provides status to define, schedule, and accurately estimate the task duration for project schedule.
Possesses unwavering commitment to customer service and operational excellence.
Keeps abreast of new technology and market developments.
Adheres to CNSI CMMI standards and processes.
Manages internal customer relationships for long-term corporate success

Talent Development:

Requests and gives both negative and positive feedback.
Recruits highly skilled, motivated leaders and individual contributors and recommends potential new hire resources to meet client commitments in alignment with program delivery.


Familiarity with medical bill and provider enrollment forms.
Identify reoccurring problems and provide feedback to management to affect change.
Familiarity with payment adjustments, claim disputes, prior authorization, claims processing,
Manage sensitive data in accordance with HIPAA and Medicaid regulations.

About us:

We are proud to be a partner to the public sector, a trail blazer in health IT and a passionate advocate for better health, better care and lower costs for millions of Americans. Innovation is core to our DNA and through our iCare program we invest in the well-being of our employees and the communities in which we live and work. You will be offered a solid compensation package which includes:


  • Annual and Other Paid Leave
  • Medical/Dental Insurance
  • Flexible Spending Account (FSA) Plan
  • Disability Insurance (Short & Long Term)
  • Life Insurance
  • 401(k) Retirement Savings Plan
  • Employee Assistance Program
  • College Savings Plan
  • Tuition & Training Assistance
  • Paid Holidays
  • Employee Referral Program


CNSI maintains a policy supporting equal employment opportunity. Employment decisions at CNSI are made without regard for race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status or any other status protected by applicable Federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.





  • 15 year(s): Experience in project planning, delivery, and management
  • 2 year(s): Experience in provider management, claims processing, prior authorization, and/or other related projects.
  • Demonstrates leadership skills and ability to work effectively with different teams and contributors both directly and in a matrix environment.
  • Domain knowledge of Medicare, Medicaid, or healthcare verticals.
  • Ability to manage people, projects, and processes.
  • Strong understanding of project management skills and ability to create and manage project plans.
  • Expertise in Microsoft Schedule
  • Understanding of SharePoint applications, WebEx, Skype, etc.


  • Familiarity with medical bill forms, ICD-9/10CM coding, CPT coding, bill forms, and other medical coding schemes.
  • Ability to meet and enforce deadlines, to conduct research into technology issues and products, and to take initiative in the development and completion of projects.
  • Knowledge of Microsoft Word, Excel, and Visio with a working knowledge of the rest of the Microsoft Office suite of applications.
  • Strong knowledge of Microsoft Project EV metrics.
  • Strong problem-solving, analytical, and evaluative skills.
  • Strong communication skills (verbal, written, facilitation) with strong presentation and facilitation skills.
  • General knowledge of medical terminology



  • Bachelors or better


  • Masters or better

Licenses & Certifications


  • Prof in Project Mgmt Cert



  • Team Player: Works well as a member of a group
  • Leader: Inspires teammates to follow them
  • Functional Expert: Considered a thought leader on a subject
  • Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35©


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Health Survey Specialist / Service Advocate- Work at Home Job in Louisville, KY at Aetna

Req ID: 71883BR Job Description Program Overview Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.

With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Fundamental Components included but are not limited to: Position Summary The Health Survey Specialist plays a critical role within the DSNP team.

The Health Survey Specialist outreaches DSNP members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA). The HRA is the first step in creating the member’s Individualized Care Plan and sets the foundation for follow up care management by assessing a member’s medical, functional, cognitive, psychosocial, and mental health needs. Fundamental Components + Uses motivational interviewing and other consultative techniques to gather comprehensive information about a member’s medical, functional, cognitive, psychosocial, and mental health needs + Accountable to the highest level of compliance integrity + Champions for the member by connecting members with urgent needs to the appropriate Aetna team, including DSNP’s interdisciplinary care team and customer service + Initiates engagement with assigned members to introduce the program and drive active participation in completion of their Health Risk Assessment + Builds a trusting relationship with the member by engaging the member in meaningful and relevant conversation, prior to and during assessment + Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate + Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed + Accurately and consistently documents each call in the member’s electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements + Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA + Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm + Determined to build strong relationships with peers and our DSNP members + Demonstrates an outgoing, enthusiastic, and caring presence over the telephone Qualifications Requirements and Preferences: + At least 3 years of experience in health care, customer service, telemarketing and/or sale + Familiarity with basic medical terminology, health care, and the concepts of care management + Medicare/Medicaid/DSNP experience preferred + Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel required + Strong organizational skills, including effective verbal and written communications skills required + Data entry and documentation within member records is strongly preferred + Flexibility with work schedule to meet business needs + Bilingual desired Education and Certification Requirements + High School diploma or G.E.D.

required + Associates/Bachelor’s degree preferred Benefit Eligibility Benefit eligibility may vary by position. Job Function: Customer ServiceAetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.


Clipped from:,KY?jid=803c0c97550317ef&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Claims & Encounters Senior Advisor- Work From Home Opportunity – Cigna


Remote or Bloomfield, CT

$162,366 yearly est.

**Job Summary:**

_Medicaid Claims & Encounters Senior Advisor position_ is the _encounters_ subject matter expert and responsible for working with IT and Claims and other operational areas, to ensure the accurate, timely and efficient submission of claims and encounters.

Works with IT and business leadership (corporate and market based) to effectively provide access to information and data to maintain business lead by the organization of state and federal regulatory reporting.

Together with internal functional partners, ensure we meet or exceed Medicaid and Medicare claims and Encounter requirements related to the State of Texas Medicaid and MMP programs and internal goals. Perform various analysis and interpretation to link business needs and objectives for assigned function by:

+ Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems.

+ Ensuring Encounter submissions meet state requirements. Perform necessary data pulls and analytics to pre-determine failures in encounter data extracted from claims system.

+ Identify and analyze user requirements, procedures, and problems to improve existing processes.

+ Ensure BA’s and other analysts processing files are keeping up to date, informed of changes and following through with them.

+ Complete the monitoring of submission, transmission and acceptance rates and provide reporting around each as required.

+ Reviewing, researching, investigating and correcting encounter issues through data and process analysis.

+ Where process or system changes are necessary, develop short and/or long-term resolutions by identifying root causes using data files, provider files, diagnosis files, etc.

+ Develop collaborative relationships with internal partners to ensure Encounter goals are met; includes partnering with functional teams (e.g., Provider Data, Claims, etc.) accountable for issues impacting Encounters.

+ Resolve issues and problems by conferring with those internal and external clients as necessary.

+ Support internal and external partners for reporting requirements.

+ Analyze the integrity of data, diagnose issues and test changes.

+ Participates in change management procedures to support accurate data documentation and process flow supporting the reporting requirements.

+ Develop and maintain all Encounter reporting technical documentation.

+ Maintain Encounter reporting describing results against internal goals; presenting results and issue updates

+ Develop, share, and incorporate organizational best practices into business applications

+ Develop relationships with state partners to research issues.

+ Regularly (Quarterly) review processes and work collaboratively with other BA’s and other analysts to improve automation and accuracy of submissions.

+ Identify trends / issues / deficiencies regarding monthly submission files and feedback files; oversee or resolve errors by working with other key departments; determine whether there is a need for process improvement or modification to ensure proper submission of all encounters; document testing; maintain record / file of all these interactions and of any changes.

+ Serves as Medicare and Medicaid Encounter Subject Matter Expert (SME) for state of Texas and other states acquired as necessary.

+ Support management requests for reporting based on various performance measures/data within the organization

+ Lead system testing to validate the rollout of new functionality.

+ Ability to perform some travel.

+ Other duties as assigned by supervisor/organizational leadership.

+ Maintain professional contact with other departments as needed; attend interdepartmental meetings.

**Minimum Qualifications:**

+ Bachelor’s degree preferred or equivalent experience.

+ 4+ years of business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience.

+ Experience with encounters or claims business analysis experience in healthcare, preferably managed care or Medicaid Advanced knowledge of Microsoft Applications, including Excel and Access preferred.

+ Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred.

+ Previous structured testing experience preferred. Compliance Coding/Prepay Compliance (Payment Integrity).

+ Knowledge of HIPAA transactions (i.e. 837, I, P, 999, 824, 277,820, 834) and SQL Scripting preferred.

+ Experience managing projects with a high reliance on technology.

+ Experience in Project Management

This position is not eligible to be performed in Colorado.

**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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response._

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DSNP Member Advocate – Work At Home

CVS Health

La Place, LA Full-timeWork from home

  • Help us elevate our patient care to a whole new level!
  • Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models.
  • You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.
  • With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs.
  • Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.
  • Required Qualifications The Member Advocate works alongside other DSNP care team members including social workers, care managers and care coordinators to provide the best member experience.
  • Educates and assists members on various elements of Medicaid entitlements, benefit plan information and available services created to enhance the overall member experience with the company.
  • Utilizes all relevant information to effectively influence member engagement.
  • Initiates contact with members who have lost Medicaid eligibility and fall into DSNP grace period to remind them to reobtain Medicaid and LIS recertification.
  • Assists members with finding resources to help them reapply if necessary.
  • Coordinates and sends annual reminders for members at risk of losing LIS, Medicaid, or DSNP eligibility.
  • Takes ownership of each customer contact to anticipate customer needs, resolve their issues and connect them with additional services as appropriate.
  • Tracks member’s Medicaid certification and eligibility dates and MCO plan information, as well as Medicaid status.
  • Researches other general Medicaid programs and entitlements the members are eligible for and initiate process to inform members of these benefits.
  • Completes accurate case documentation as needed.
  • Works with National DSNP Program Office Medicaid Policy Manager and State Contract Manager to provide general assistance with Medicaid benefits and entitlements.
  • Preferred Qualifications In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other benefits), related financials, legal/regulatory requirements.
  • Knowledge and understanding of 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 work independently, accurately, and e efficiently.
  • Innovative Thinking and “Change Agent” Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.
  • Empathy towards customers’ needs and concerns.
  • Education Associate’s degree or equivalent work experience.
  • Business Overview At 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.

Posted 18 days agoInactive Job

Links for CVS Health


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Medicaid Transportation Advocate


Medicaid Transportation Advocate (54561)

Remote Opportunity To Work From Home!
Must live within a commutable distance of Syracuse, NY

HOURS: Monday – Friday 9:30am – 6:00pm or 11:30am – 8:00pm

PAY RATE: $16/hr.

CPS Recruitment is partnering with an established, 24-hour Call Center in Downtown Syracuse, NY to find 10 Medicaid Transportation Advocates to become a vital part of their growing team!

Work for a leading Medicaid transportation company that offers full-time and temp-to-hire opportunities.

If you have a positive attitude, enjoy working in a team environment and have excellent customer service skills – apply today!

Training begins 11/30/2020!

Duties & responsibilities include, but are not limited to, the following:

  • Answer a high volume of inbound calls in a professional and courteous manner
  • Monitor driver trips
  • Override invoices
  • Escalation calls
  • Assist employees with questions
  • Ensure full Medicaid compliance
  • Assist with vendor relations and county specific tasks
  • Other duties assigned by management

Minimum Qualifications:

  • High School Diploma or GED
  • Healthcare or Medicaid background desired
  • Able to work with management
  • Excellent customer service skills
  • Able to handle difficult calls

Applicants must follow the CPS employment guidelines and be willing to comply with our drug screening policy and other pre-employment requirements.

How to Apply:
For consideration please submit a resume to the following:
Further questions, call 315-883-5507

CPS Recruitment is an Equal Opportunity Employer

CPS Recruitment is an Equal Opportunity Employer.


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