Posted on

Senior Sales Executive – Payment Integrity/Accuracy – Medicaid Software Solutions, Boston, Massachusetts

 
 

YOU MUST CURRENTLY SELL PAYMENT SOFTWARE AND SERVICES TO STATE MEDICAID AGENCIES TO QUALIFY FOR THIS POSITION. Leading provider of financial and clinical products is seeking a Senior Sales Executive for their Payment Integrity and Accuracy – State Medicaid division.

You can be located anywhere in US. Responsibilities:.Selling to Medicaid Agencies and Fiscal Intermediaries Achieving quotas as set by company.Negotiate and close contracts.


Working with a team of sales, account management and product management to satisfy customer needs Requirements:.7 plus years of documented success achieving 1M plus quotas.Currently selling Payment software and Payment services directly to State Medicaid Agencies Must have knowledge of Payment Accuracy solutions and Integrity solutions.


Knowledge of Cost Containment/Fraud/Wast abuse, SIU solution in the payer market is a plus Must be willing to travel 70%.Must have BA/BS Income – Base – $135,000 OTE $275,000 PLEASE RESPOND TO THIS POSITION BY EMAILING YOUR RESUME TO (see below) WITH 5602CH IN THE SUBJECT LINE..


Clipped from: https://jobs.kxan.com/jobs/senior-sales-executive-payment-integrity-accuracy-medicaid-software-solutions-boston-massachusetts/664132669-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Customer Service ( Medicare and Medicaid Job Irving Texas USA,Language/Bilingual

 
 

Position:  Customer Service ( Medicare and Medicaid )
Job Description

Required Function 1:


We are seeking a talented individual for a Subrogation  is responsible for answering all casualty or estate ficiaries or deceased Medicaid beneficiaries. This includes, but is not limited to calls from attorneys, paralegal, insurance agents, Medicaid members and their families.


Required Function 2:


Essential Responsibilities:


Effectively review and update a variety of cases with current and accurate case notes Provide case status updates while speaking with multiple parties such as attorneys and members regarding their case history, current status and next steps. Conduct all case document review and updates while speaking with the member or attorney as needed Maintain a daily system of providing timely and accurate information required to move cases through the case management workflow.


Interact professionally (incoming and outgoing calls and correspondence) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client. Perform basic and advanced levels of document review to identify current case status and case management and ensure case progress through workflow Meet department objective standards for Customer Service Verify and adhere to HIPPA standards while speaking with members and attorneys on the phone Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information).


Open new cases and update all current case information


May have additional responsibilities as needed to assist with case intake and verification process tasks


May have some training responsibilities limited to projects and specific tasks


Required Function 3:


Non

Essential Responsibilities:

Performs other functions as assigned


Required Function 4:


Knowledge


Skills and Abilities:


Ability to
interface with all levels of people both internally and externally in a professional manner.


Ability to communicate and comprehend well both verbally and in writing, fluently in English.


Ability to be careful and thorough about detail including with cite-checking and proofreading skills.


Ability to multi-task and prioritize effectively.


Ability to work proficiently with Microsoft Office, Word, and Excel required


Ability to work independently to meet objectives.


Ability to analyze information and use logic to address work-related issues and problems.


Ability to perform oral presentations with good quality.


Ability to perform well in team environment, to achieve business goals.


Ability to maintain a high level of confidentiality and ethics.


Ability to function effectively under pressure and manage deadline oriented project demands and multiple initiatives.


Ability to sit for long periods of time.


Ability to perform the following: lifting, bending, pushing, pulling, stopping, kneeling, reaching, and carrying of light to heavy items (40 to 50lbs). Average manual dexterity work in use of a PC, phone, sorting, filing and other office machines.


Required Function 5:


Minimum Education:


High School ciates degree preferred


Required Function 6:


Minimum Related Work


Experience:


1+ years experience working in a professional office environment.


Experience working in a rience in the insurance industry (casualty or health insurance) a plus Knowledge of Microsoft Word and Excel required. Medicaid and/or Medicare knowledge preferred. Bilingual (Spanish & English) a plus.


Nothing in this job description restricts managements right to assign or reassign duties and responsibilities to this job ription


Della Infotech Inc is in the staffing business for 10 years. Over the years, we have placed hundreds of candidates to various temp and permanent positions with our 50+ happy clients all over US and Canada including Fortune 500 corporations.

 
 

Clipped from: https://www.learn4good.com/jobs/irving/texas/language_and_multilingual/1365622804/e/

Posted on

RN Provider Clinical Liaison – Region 4 – Medicaid Job in Durham, NC at Elevance Health

 
 

Description

RN Provider Clinical Liaison – NC Medicaid – Region 4 (JR7522)


Location: This position is remote. Qualified candidates must reside in North Carolina in the geographic area supported for commuting purposes. This role will oversee providers in Region 4 which includes Wake, Wilson, Johnson, Durham, and surrounding counties.


The Provider Clinical Liaison for North Carolina Medicaid (Region 4) supports primary care groups in Advanced Medical Home population health activities. This position serves a key role in Healthy Blue’s geographically organized provider support. The Clinical Liaison is responsible for managing quality and medical expense goal metrics for primary care groups by assisting in connecting high risk members and those having HEDIS gaps to their medical homes, to establish care plans that improve health outcomes.


Primary duties include:

  • Use Healthy Blue databases and tools, including risk adjustment tools to identify opportunities for improvement in quality and costs for members in assigned practices
     
  • Develop an operational plan for each medical practice to deploy office personnel and coordinate with Healthy Blue resources to optimize performance on targeted quality measures and to improve clinical and cost outcomes for members identified to have high clinical risk
     
  • Coordinate scheduling of high-risk members and those having HEDIS gaps for appointments
     
  • Communicate with medical office personnel about identified gaps in care that will be apparent to the practitioner at the patient encounter
     
  • Meet with physicians and other clinical personnel to problem solve and develop engagement plans for high-risk members
     
  • Work with practitioners and office staff to improve documentation of diagnoses, including specific manifestations, facilitate access of members to Healthy Blue case management, population health, and behavioral health programs as indicated, and help coordinate services provided by practice and Healthy Blue personnel
     
  • Serve as the subject matter expert for primary care practices on all Healthy Blue clinically focused program
     
  • Conduct periodic meetings with each practice to track progress towards implementing the project plan and attaining goals established in the engagement contract
     
  • Support the Healthy Blue Provider Collaboration Lead in organizing and implementing support to achieve targeted revenue, medical expense, and quality goals for the assigned region
     
  • Assures compliance to practice guideline, delegation and continuity and coordination of care standards
     
  • Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
     

Minimum Requirements:

  • BA/BS in Nursing and minimum of 5 years of medical management experience; or any combination of education and experience, which would provide an equivalent background.
     
  • Current unrestricted RN license in the state of North Carolina required.
     
  • Must reside in the geographic area you will be supporting.
     
  • Minimum 5 years of clinical experience.
     
  • This position requires field work, visiting providers, as needed, up to 75% of the time.
     

Preferred Qualifications:

  • Experience with clinical data analytics / risk adjustment tools.
     
  • Advanced Excel skills + Word and Outlook.
     
  • Tableau a plus!
     
  • MS or advanced degree preferred.
     

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.ElevanceHealthinc.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.

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.

Clipped from: https://www.ziprecruiter.com/c/Elevance-Health/Job/RN-Provider-Clinical-Liaison-Region-4-Medicaid/-in-Durham,NC?jid=a5d3090262213a92&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Medicaid/Medicare Services Specialist I job in Frankfort, KY 40601 | State of Kentucky

 
 

 
 

The Kentucky Transportation Cabinet is committed to meeting or exceeding the needs and expectations of our customers. Our focus is on people: our customers, our employees, and our partners. We will continually improve both the delivery of our products and services and the processes that support that delivery to provide a safe, efficient, environmentally sound, and fiscally responsible transportation system that delivers economic opportunity and enhances the quality of life in Kentucky.

By joining our Office of Transportation Delivery as a Medicaid/Medicare Services Specialist I in Franklin County, you’ll have the opportunity to perform multi-faceted functions for the Medicaid Non-Emergency Medical Transportation Program (NEMT) providing assistance in determining recipient transportation eligibility.

Holders of the Medicaid/Medicare Services Specialist I position will complete tasks such as:

  • Providing assistance to program recipients, medical providers, and/or other agencies and general public in receiving and investigation Non-Emergency Medical Transportation complaints and inquiries.
  • Receives statewide calls on the customer service complaint line from recipients, Brokers, medical providers, and other agencies. This position will have much telephone communication work.
  • Accurately determines recipient Non-Emergency Medical Transportation eligibility for requested covered services. Works with the Department for Medicaid Service, Vocational Rehabilitation, Blind Services and Department of Correction programs.
  • Issues trip denials and/or trip approvals to recipients and Brokers in a timely manner. Forwards denial letters for processing. Files denial letters in appropriate folder.

Holders of this job will obtain the following skills:

  • Telephonic customer service skills
  • Letter writing.
  • Communication skills
  • Dispute resolution skills

Desired candidates possess the following requisite skills or experience applicable to the position:

  • Good customer service skills.
  • Active listening skills.

Required to possess a valid driver’s license, some travel will be required for professional trainings, incumbents in this job title should possess the ability to work sit, stoop and bend. Sitting at a desk and answering the telephone is a major component in the job tasks expected.

Applicants must be currently authorized to work in the United States for any employer.

The Kentucky Transportation Cabinet (KYTC) participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in U.S. KYTC will only use E-Verify once you have accepted a job offer and completed the Form I-9.

For more information on E-Verify, or if you believe that KYTC has violated its E-Verify responsibilities, please contact Department of Homeland Security (DHS) at 888-897-7781 or https://www.e-verify.gov/.

If you are looking for a rewarding career with a culture of employee involvement, where teamwork is the norm and measurement of performance is essential, the Kentucky Transportation Cabinet is for you!

We look forward to reviewing your application.

Minimum Requirements

EDUCATION: Graduate of a college or university with a bachelor’s degree.

EXPERIENCE, TRAINING, OR SKILLS: NONE

Substitute EDUCATION for EXPERIENCE: NONE

Substitute EXPERIENCE for EDUCATION: Experience in Medicaid and/or Medicare program administration, health insurance administration/systems, eligibility systems, health care research, health care planning, health care financial management, health care policy development or human service or health care administration, insurance billing and/or claims will substitute for the required college on a year-for-year basis. Current or prior military experience will substitute for the required college on a year for year basis. Prior military experience will only substitute if the individual received an honorable discharge, discharge under honorable conditions, or a general discharge.

SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE

Working Conditions

Incumbents working in this job title primarily perform duties in an office setting.

Probationary Period

This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.

If you have questions about this advertisement, please contact Jeremy Thompson at Jeremy.Thompson@ky.gov or 502-564-7433.

 
 

Clipped from: https://getwork.com/details/2567608859d475d92f126c957661c677?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Healthy Connections Director, Medicaid Job in Murray City, OH at Intermountain Healthcare

 
 

Job Description:
SelectHealth is a not-for-profit community health plan serving more than one million members in Utah, Idaho, and Nevada. As part of an integrated system with Intermountain Healthcare, we share a mission of “Helping people live the healthiest lives possible” to ensure our members and the communities we serve have the highest quality healthcare at the lowest possible cost.

SelectHealth’s line of businesses (LOB) include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans and fully-funded and self-funded Commercial plan. The Healthy Connections Director is responsible for the development, implementation, evaluation, and operational management of SelectHealth’s Healthy Connections care management and utilization review programs for the line of business(s) which this position oversees. The position requires an understanding of care management and utilization management industry benchmarks, best practices and regulatory environment for the line of business function.


This position is based out of the SelectHealth office in Murray, Utah and required regular in-office presence 2-3 days per week.


Reporting to the Senior Director of Health Connections, this position supports development and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order to provide a seamless experience for our members as they cross the full continuum of their healthcare journey. It oversees all Healthy Connections program components related to care management and utilization review for the specific line of business, across all service areas and multiple states and assists the Senior Director and CMO in scaling care management and utilization review operations that supports membership growth, acquisitions and expansion into new service areas in a strategic and efficient way.


Ensures SelectHealth offers competitive programs, monitors medical expense trends for the product line and works with CMO and Senior Director to evaluate or add programs to impact trends. Uses a data-driven approach to assess utilization management and care management operations and make program recommendations. For Interdisciplinary Care Management, develops structures and processes to facilitate care coordination among treating physicians, pharmacists, behavior health professionals, and other treating providers in multidisciplinary care planning and care delivery. Collaborates with our network partners through joint operating committees to assure program development and integration and coordinates activities across department lines to meet operational objectives of SelectHealth.


In addition, the position oversees effective services and outcomes for members by monitoring the care management process. Supports management team in leading daily operations of their respective disciplines. Establishes standards for staffing and case load management based on industry benchmarks for comparable programs and guides leadership team to assure standards for documentation, policies and procedures are met. Is actively involved in maintaining quality practice as defined by NCQA, CMS and / or other regulatory agencies. Leads change initiatives and acts as a subject matter expert sharing an understanding and explaining organizational, regulatory and operational changes to the teams in assigned line of business. Has clear understanding of organization and department goals and how the work aligns with strategies and uses that knowledge to align messaging and expectations with the leadership team and helps the team solve problems and offer alternate solutions.


Minimum Qualifications

 

  • Bachelor’s or master’s degree in clinical specialty, such as Nurse, LCSW, Nurse Practitioner, Physician’s Assistant, Physical or Occupational Therapy. Education is verified.
  • Current associated clinical license in state of Utah.
  • Experience working in a managed care environment and have familiarity with the regulatory environment pertinent to the Line of Business (LOB) they will oversee (e.g. NCQA, CMS).
  • Three years of clinical experience, preferably in a variety of settings.
  • Previous leadership or management experience in a managed care environment including organizational and program development skills requiring demonstrated knowledge of care management, utilization management and insurance industry.
  • Experience with financial reporting and analysis, preferably in a managed care setting.
  • Demonstrated problem-solving ability.
  • Demonstrated excellent verbal, written and interpersonal communication skills.
  • Demonstrated public speaking and presentation skills.

Preferred Qualifications
 

  • Experience working in Medicaid programs (e.g. waiver programs, programs that restrict over-utilizers, familiarity with unique Medicaid state rules, etc.)
  • Experience running government program(s) and leading these teams
  • Familiarity with federally qualified health centers, community-based behavioral health services, inter-disciplinary team conferences, building and staffing models of care for care management.

#LI-EXECRC

Physical Requirements:


Location:

SelectHealth – Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$56.61 – $87.39

For a description of Intermountain’s employment benefits, click


HERE.

 
 

Clipped from: https://www.ziprecruiter.com/c/Intermountain-Healthcare/Job/Healthy-Connections-Director,-Medicaid/-in-Murray-City,OH?jid=6ce9b556ea1ab6e5&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Senior Manager – Medicaid Health Transformation Services | Deloitte

 
 

Are you interested in working in a dynamic environment that offers opportunities for professional growth and new responsibilities? Are you interested in helping clients drive transformative healthcare solutions? Are you interested in joining an actuarial practice that is a leading global advisor and implementation partner working with State and Federal governments, health plans, providers, drug and device manufacturers and other organizations around the world? If you are seeking a role that offers you the opportunity to advise Government and Public Services (GPS) clients through critical and complex issues, while allowing you to develop personally and professionally, consider a career in Deloitte’s Actuarial and Insurance Solutions practice.


Work you’ll do


The Senior Manager will be expected to lead complex client initiatives and engagement teams working on Medicaid related projects. They will support the development and maintenance of strong relationships with senior client leadership. They should help develop the more junior members of the engagement team and deepen their understanding of the political, policy, financial and business aspects of the Medicaid program.


Delivery expectations of the Senior Manager includes:


  • Anticipates client needs based on a strong understanding of the client and its industry and marketplace.
  • Determines client needs by guiding teams in selecting and applying the most appropriate tools, techniques, and approaches to understand the client’s issues and opportunities.
  • Integrates recommendations into a total solution for the client that is consistent with the engagement strategy.
  • Challenges and enhances quality by consistently striving for ways to improve deliverables.
  • Directs the team to provide exceptional service to the client by responding with a sense of urgency, practicality, accountability, integrity, and respect.
  • Communicates regularly with client management on a variety of business topics (e.g., trends, innovations, problem-solving discussions)
  • Demonstrate specific service area/competency and/or industry expertise that resulted in tangible value for the client.


Market, Sales, and Communication: The Senior Manager will be expected to broaden relationships at the most senior levels within current and potential state and local healthcare clients and to translate this into new business opportunities. They will work closely with the practice to win additional consulting work with the existing accounts and to acquire new accounts.


The team


With more than 40 years of experience in assisting state health and human services agencies in nearly every state, Deloitte understands how delivery works-and how it can work better. Our state health team offers industry-leading insights, solutions, and business practices to help state health agencies solve their most difficult challenges, ranging from modernization of eligibility determination systems and compliance with Federal Health Insurance Exchange requirements to innovative Medicaid tools and services that can help states serve their constituents more effectively.


Deloitte helps state Medicaid agencies design and implement initiatives that improve upon the management of their health programs, overall financial performance, and health outcomes. Our advisory services and solutions focus on four critical areas: policy and program design, analytics, organizational transformation, and ongoing program evaluation. In an environment in which states are being asked to do more with less, Deloitte brings a wealth of knowledge, experience and solutions to help health agencies plan for the future.


Qualifications Required:


  • At least 10 years of healthcare experience working either with a state Health and Human Services agency or with a health plan or consulting company serving healthcare clients. Demonstrated experience working on Medicaid related issues including Medicaid managed care, value-based purchasing, 1115 transformation waivers, social determinants for health, managed long term services and supports, home and community based services, physical and behavioral health coordination, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations
  • Track record of leading and growing strong teams of management consultants or other organizational groups, with ability to manage across multiple engagements
  • Outstanding leadership skills, verbal and written communication skills, presentation skills, team working skills and ethical standards. This individual should be looked upon as a role model who instills the pride, values and integrity of Deloitte in their team.
  • Experience supporting Medicaid programs
  • Experience mentoring and coaching others
  • Business development experience (pre-sales, proposal, and RFP experience)
  • Experience leading teams and managing client/executive relationships
  • Willingness to travel at least 25%


Proficient PowerPoint, Word, Visio, Access, and Project

For individuals assigned and/or hired to work in Colorado, Deloitte is required by law to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the State of Colorado and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and delivery model. We would not anticipate that the individual hired into this role would land at or near the top end of the range, but such a decision will be dependent on the facts and circumstances of each case. A reasonable estimate of the range is $131,000 – $219,000. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-manager-medicaid-health-transformation-services-at-deloitte-3143851691/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Business Analyst – Medicaid Eligibility & Enrollment (Remote U.S.) by CNSI

 
 

Job Description

 

At CNSI, we are innovators, developers, engineers, and architects, who each play a vital role in our mission: Empowering our clients to improve the health and well-being of one in five Americans. If you want to join a company that uses technology to revolutionize healthcare, let’s talk!

WHAT WE DO:

CNSI is empowering the delivery of public sector healthcare in claims and encounter processing platforms, provider support solutions, and promoting consumer engagement and interoperability. Our configurable, modular, scalable platform, evoBrix X™, powers robust data analytics, risk reduction and regulatory compliance, and fiscal agent operations for our clients.

CNSI’s technology-enabled products and solutions connect consumers, payers, and providers to improve health outcomes for one in five Americans.

The selected candidate will be able to work remotely in the U.S. with up to 50% travel for client and team meetings, and trainings.  Candidate located in the Atlanta, Georgia area preferred.

CNSI is currently looking for an experienced Business Analyst to join our growing team! 

Summary:

As a Business Analyst you are responsible for analyzing business problems, identifying gaps, and developing technical solutions involving complex information systems under no supervision for Medicaid Eligibility and related subsystems. This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases; provide day-to-day direction on State program activities.

Responsibilities:

  • Works with customers on presenting technical solutions for complex business functionalities
  • Possesses unwavering commitment to customer service and operational excellence
  • Provides customer support through leading client demos and presentations
  • Prioritizes and schedules work assignments based on the project plan, handling multiple tasks across project phases
  • Creates and modifies Business Process Models
  • Understands the overall system architecture and cross-functional integration
  • Demonstrates in-depth knowledge of business analysis relates to Member Eligibility and Enrollment to ensure high quality
  • Demonstrates advanced expertise and contributes to the Business Analysis practice by publishing technology points of view through the creation of white papers
  • Possesses in-depth knowledge and is well-versed in multiple functions or capabilities
  • Uses cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications
  • Analyzes user requirements and client business needs, leveraging expert opinion and expertise
  • Acts as the requirements subject matter expert and supports requirements change management

To learn more about what we are doing, check us out at (url removed)

Industry Recognition – Press Release: (url removed)

 
 

Clipped from: https://www.resume-library.com/job/view/73814802/business-analyst-medicaid-eligibility-enrollment-remote-u-s?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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CMS- Health Insurance Specialist

Clipped from: https://www.usajobs.gov/job/665547600?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Department of Health And Human Services

COVID-19 Vaccination Requirement

The COVID-19 vaccination requirement for federal employees pursuant to Executive Order 14043 does not currently apply. Some jobs, however, may be subject to agency- or job-specific vaccination requirements, so please review the job announcement for details. Click here for more information.

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare, Medicare Contractor Management Group (MCMG)/ Eastern MAC Program Management Division (EMPMD).


As a Health Insurance Specialist, GS-0107-14, you will serve as a Contracting Officer’s Representative (COR) for the needs and requirements for two or more assigned Medicare Administrative Contractors (MACs).

Learn more about this agency

Videos

 
 

Help

Duties

  • Perform analyses of operational policy and program operations to evaluate the appropriateness, cost effectiveness, or other impact resulting from the implementation of law, regulations, policy, or operational procedures and systems.
  • Serves as a resource person for analysts within CM, CMS, HHS, and congressional staffs within the assigned areas of responsibility.
  • Represent senior Center for Medicare (CM) officials in discussions with senior Center for Medicare and Medicaid (CMS) and Departmental officials, congressional staffs.
  • Functions as the Contracting Officers Representative (COR) for assigned MAC contracts, including providing expertise for all functions and tasks performed by such contractors and all aspects of the administration of such contracts.
  • Plan and develop the detailed specifications for the MACs, including direction, operation, and implementation requirements.

Help

Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-14 , you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in either the private or public sector, to include:

(1) Administering health-related or insurance-related contracts; (2) Developing and evaluating Medicare policies or contracts; and (3) Leading projects or teams related to contract administration.



Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11568562

Education

There is NO substitution and/or requirement of Education for this position.

Additional information

Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923
Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required



Federal agencies may request information regarding the vaccination status of selected applicants for the purposes of implementing other workplace safety protocols, such as protocols related to masking, physical distancing, testing, travel, and quarantine.


Expanded/Maximum Telework Posture: Due to COVID-19, the agency is currently in a maximum telework posture. If selected, you may be expected to telework upon your appointment. As employees are permitted to return to the office, you may be required to report to the duty station listed on this announcement, even if your home/temporary telework site is located outside the local commuting area. Your position may be eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the CMS Master Labor Agreement.


Full-Time Telework Program for CMS Employees: CMS employees currently participating in the Full-Time Telework Program must discuss whether they can remain in the program with the hiring manager. If an employee in this program is selected, the pay will be based on the address on the current telework agreement (normally home address) and will be used as your official duty station for pay purposes. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Once the announcement has closed, your online application, resume, and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.


Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):


  • Analysis
  • Contracting/Procurement
  • Oral Communication
  • Oversight
  • Written Communication

Additional selections may be made from this announcement for similar positions within CMS in the same geographical location. For Central Office vacancies, the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

  • Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 07/24/2022 to receive consideration.


    IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


    We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to Antonio.Phillips@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Agency contact information

Antonio Phillips

Email

Antonio.Phillips@cms.hhs.gov

Address

Center for Medicare
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,07/24/2022, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

  • The Federal hiring process is setup to be fair and transparent. Please read the following guidance.

 
 

Help

Required Documents

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 07/24/2022 to receive consideration.


IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to Antonio.Phillips@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Read more

Agency contact information

Antonio Phillips

Email

Antonio.Phillips@cms.hhs.gov

Address

Center for Medicare
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,07/24/2022, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

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