Job ID: CP-1041449
Description:
BASIC FUNCTION:
This position will be responsible for setting the strategy and managing operational oversight of the Oklahoma Medicaid reporting functions. The role will provide oversight to ensure all Oklahoma Medicaid data conforms to OHCA data standards and policies. This position will have extensive experience in managing data quality and exchange processes, including data integration and verification. The incumbent will serve as a liaison supporting key functional areas in the development and implementation of the Oklahoma Medicaid reports and deliverables.
JOB REQUIREMENTS:
- Bachelor’s degree and 4 years of experience in contract management OR 8 years of experience in contract management.
- Leadership experience
- Data management experience, including applying consultative, negotiations, analytic and problem-solving skills to drive completion of data projects and initiatives.
- Project management/planning skills.
- Experience in a position requiring independent and critical decision making skills.
- Experience communicating with and relationship building with internal business units and/or various external government agencies.
- Experience leading/providing guidance to intra and interdepartmental staff.
- Experience accurately documenting information reported.
- Organizational, analytical and decision-making skills.
- Negotiation skills resulting in business/process improvements/changes.
- Clear and concise interpersonal, verbal and written communication skills.
- Presentation skills.
- Project positive, professional image.
PREFERRED REQUIREMENTS:
- Experience with corporate policies / procedures, compliance regulations in health care administration/managed care experience
- Experience working with EDI transactions and other industry standards such as:
1) 837P/I/D (Medical and Dental Claims submission)
2) NCPDP (RX Claims)
3) 277CA, 999 (Claims response files)
4) 834 (Enrollment)
5) 820 (Remittance)
- Experience with reviewing complex technical specifications and working with vendors, state/federal agencies, and IT teams to implement or change application processes
- Experience with health care data such as claims, encounters, provider and membership
- Experience with data quality, mining, testing, and solving issues/defects
- Experience with relational databases and SQL
- Experience with data extraction/load, exchange interfaces and protocols such as SFTP
- Advanced degree in Computer Science or related field
This position is based in Oklahoma City, OK.
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.
Requirements:
Expertise Analytics & Reporting Job Type Full-Time Regular Location OK – Oklahoma City
Associated topics: automobile, claim adjuster, claim examiner, claimant, damage, fraud, insurance adjuster, insurance investigator, investigation, liability adjuster
Read the full job description and apply online on the recuiter’s web-site