Author: MM_ADMIN

 
 

State of Idaho

Job Posting for Reimbursement Analyst – Medicaid Bureau of Financial Operations at State of Idaho

 
 

The Idaho Department of Health and Welfare, Division of Medicaid, is currently seeking a Medicaid Reimbursement Analyst. This position is located in the Bureau of Financial Operations in Boise.

We are seeking candidates with strong leadership abilities; experience researching and analyzing documents to ensure compliance with federal and state laws, regulations, and accounting principles; communication and interpersonal skills; problem solving skills; critical thinking skills and team learning competencies.

The ideal candidate is one with the ability to multi-task, work independently and have strong organization skills as well as detail orientation. The primary focus is to manage and create appropriate reimbursement for state services. These services include multiple provider types, such as hospitals, nursing facilities, durable medical equipment suppliers, school-based service providers. The Reimbursement Analyst is responsible for updating rates, verifying payments, calculating payments, creating policy, managing provider interaction, and reviewing reimbursement methods. These responsibilities will need to comply with regulatory requirements at both a State and Federal level. In addition, strong communication skills are required to help resolve issues with internal and external stakeholders or pending payments from government and third-party payers.

We offer a competitive benefits package which includes excellent medical, dental and vision insurance; generous vacation and sick leave accrual beginning as soon as you start; eleven paid holidays a year; participation in one of the Nation’s best state retirement systems; multiple savings plans and optional 401K; life insurance; wellness programs; ongoing training opportunities; optional telework, hybrid, or flex scheduling; and more.

If you have previously applied for the Reimbursement Analyst (Financial Specialist Senior) and wish to be considered for this vacancy, you must reapply under this announcement. Previous scores will not be used.

• Assists in review, understanding, and application of federal and state rules, regulation, guidelines, and trends and make recommendations for policy changes related to healthcare procedure codes and Medicaid reimbursement activities.
• Collaboration with technical resources and managers across the division to ensure application of rules, regulation, and guidelines are understood, communicated, and followed for reimbursement activities.
• Assists in review and analysis of Medicaid reimbursement practices, policies, and procedures to optimize reimbursement activities.
• Applies reimbursement rules and regulations to respond to questions or provide updates to internal and external stakeholders.
• Works with management to draft rule changes.
• Works with management to draft state plan amendments and waiver applications.
• Supports the development and maintenance of financial policies and procedures.
• Audit financial data for completeness and compliance with federal and state laws and regulations and conducts research into the financial needs of Medicaid.
• Assist with routine cost and analysis functions relating to provider payments and reimbursement activities.
• Consistently shows ability to recognize and deal with priorities.
• Demonstrates good judgment and reasoning when investigating and solving problems.
• Assist with other duties, tasks, or assignments as assigned by management.

You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements. The Supplemental Questions on the application are the exam questions. If it is a written answer, please make sure you answer each question with enough detail to determine how you meet the requirements. Do not put “See resume” as your answer to written questions. Answer each written question thoroughly. Failure to do this may result in not passing the exam and disqualify you from being considered for this position.

 
 

• Good knowledge of accounting principles and practices
• Experience developing and preparing financial documents
• Experience using a personal computer to develop, analyze, and report on financial data
• Experience analyzing financial activities and recommending management action

Additional Qualifications: Are not required; however, having the minimum qualifications and the education and/or experience below will increase your score.

1. Experience using data extraction tools and methods for analysis, sampling, testing and reporting. Gained by one (1) year of related full-time work experience.
2. Knowledge of Private or Public Healthcare. Gained by one (1) year of experience in a public or private health care setting or insurance billing clearing house where use of medical codes was a function of the job.

 
 

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS
 
People Making A Difference!
  
VISIT US ONLINE
 Learn About a Career with DHW
  https://healthandwelfare.idaho.gov/about-dhw/dhw-careers 
 
For all Idaho state government jobs:
  https://dhr.idaho.gov 
 
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If you have questions, please contact us at:
 
TROUBLE APPLYING:  1-855-524-5627 
(Monday through Friday, 6am – 5pm, Pacific Time)

 
EMAIL:
dhwjobs@dhw.idaho.gov 
(answered Monday through Friday during business hours MST)
Email is the quickest way to get an answer to your questions.
 
PHONE:
(208) 334-0681
(answered Monday through Friday during business hours MST)
 
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EEO/AA/Veteran

Hiring is done without regard to race, color, religion, national origin, sex, age or disability. If you need special accommodations to satisfy testing requirements, please contact the Division of Human Resources at (208) 334-2263.
 
Preference may be given to veterans who qualify under state and federal laws and regulations.

Clipped from: https://www.salary.com/job/state-of-idaho/reimbursement-analyst-medicaid-bureau-of-financial-operations/f442cd5f-b39a-4453-b7b8-c5c79e92e0b4?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

MUST reside in Ohio

Responsibilities:

The Account Executive I is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers.

•  Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations.
•  AE I maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.
•  Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products.
• Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.
• Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance.
• Uses data to develop and implement methods to improve relationship.
• Assists in corrective actions required up to and including termination, following Plan policies and procedures.
• Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues.
• Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department.
• Maintains and delivers accurate, timely activity and metric reports as required.
• Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.  

Education/ Experience:

• 1 to 3 years experience in a Provider Services position working with providers.     
• 3 to 5 years experience in the managed care/health insurance industry. 
• Medicaid experience preferred.
• Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting and problem solving skills.
• Must reside in Ohio.

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Location/Region: Columbus, OH (43215)

 
 

Clipped from: https://jobs.thejobnetwork.com/Job/474247192?SourceID=2&utm_campaign=google_jobs&utm_source=google_jobs&utm_medium=api&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

About NYC Health + Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview
Reporting to the Head of Product, the Director of Medicaid ensures operational excellence and regulatory compliance of all Medicaid products, owning the full spectrum of product strategy and operations. The Director will support key analytical activities to support the Plan’s strategic position, and will be proactive in identifying opportunities for performance improvement.

Job Description

• Provide oversight of Plan and vendor operations as they relate to the Medicaid line of business aligning outcomes to strategic goals & regulatory requirements.
• Develop & manage operational reports to track operational effectiveness.
• Partner with operational departments including Claims, Customer Service, Finance, Enrollment, Vendor Management, & Medical Management to design processes ensuring effective & efficient operations.
• Support key stakeholders in driving initiatives to meet quality & customer satisfaction goals.
• Maintain customer focus throughout Plan operations to ensure a seamless & excellent customer experience.
• Provide deep knowledge of & insight into the regulatory & market environment of Medicaid in New York to support the development of product strategy.
• Identify & integrate operational best practices, partnering with key departments to optimize processes across the organization such as benefits administration, risk adjustment, marketing & communications, customer experience.
• Monitor & analyze regulatory activity ensuring compliant operations & implementation.
• Perform competitive & market analysis.
• Partner with internal & external stakeholders on key strategic, regulatory, & operational projects.

Minimum Qualifications

• Bachelor’s degree from an accredited college or university in an appropriate discipline required.
• Master’s degree in business, healthcare or public administration strongly preferred.
• Minimum 5 years experience at a Health Plan with Medicaid Managed Care in a product management or compliance role.
• Thorough knowledge of Medicaid regulatory environment in NYS.
• Experience working with NYS enrollment transactions & encounter data submissions.
• Thorough understanding of interconnected managed care operations
• Demonstrated ability to develop workflows, policies, procedures.
• Demonstrated ability to identify opportunities for improvement & implement solutions.
• Excellent written & verbal communication skills.
• Excellent analytical skills demonstrated by an ability to use actionable data to support decisionmaking, and to proactively identify opportunities.
• Highly collaborative, and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making.
• Ability to take initiative & think independently
• Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values

Professional Competencies

• Leadership
• Results-driven
• Business acumen
• Systems orientation
• Process improvement
• Data-driven decision-making
• Customer focus
• Written/oral communication
• Resourcefulness
• Ability to work effectively in a fast-paced & constantly evolving environment

6 hours ago

Clipped from: https://us.trabajo.org/job-64-20210702-ad9f8be9373a115ac7c449d82aeff2b5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Details

Salary

$149k Per Year

Job Type

full-time

Posted

Today

Location

Albany, NY

Location:  

One Commerce Plaza, 99 Washington Ave

Albany, NY 12210

Minimum Qualifications:

Ten years of professional experience directing policy development and/or operations of large-scale public health insurance, or public health programs, at least 5 years of which include management of a large organization of professional staff engaged in the development and operation of health care policy and programs. 

Preferred Qualifications:

Expert knowledge of Medicaid, including federal and state laws, rules and requirements.  Familiarity with NY Budget and legislative processes. Experience in quantitative and qualitative analysis and evaluation health care policy. Ability to manage multiple competing priorities.  Demonstrated ability to work collaboratively with internal and external stakeholders Excellent written and oral communication skills.

Duties Description:

Serving as the Director of the Division of Program Development and Management, the incumbent will lead policy reform of the State’s $77 billion Medicaid program to advance the goal of ensuring that Medicaid’s policies and reimbursement structures pay for and incentivizes the timely provision of high quality and cost-effective care.  Responsibilities will include:  assist the Deputy Commissioner and Medicaid Director of OHIP in the overall management and operation of the Office of Health Insurance Programs; oversee the development and implementation of policies for NY Medicaid, including but not limited to policies related to services to be covered and reimbursement for such services, and staying abreast of emerging state and national trends in health care policy; serve as the lead for policy and coordination with other state agencies involved in or directly impacted by Medicaid policy, including the state Office of Mental Health, the Office of Addiction Services and Supports, the Office of Children and Family Services and the Office for People with Developmental Disabilities; establish and maintain relationships and seek input on Medicaid policy from external stakeholders including but not limited to consumer and health care provider representatives; develop and oversee the implementation and operation of federal waivers and state plan amendments needed to secure federal Medicaid funding; recommend policy to the Deputy Commissioner and Medicaid Director of OHIP as well as the Commissioner of DOH on issues related to NY Medicaid; represent the Deputy Commissioner and Medicaid Director of OHIP with Federal authorities including the Centers for Medicare and Medicaid Services, NYS legislators, and NYS control agencies, to provide and secure information necessary for the management of OHIP; oversee the evaluation of Medicaid programs including but not limited to trends in program enrollment, expenditures and service utilization, making policy recommendations based on such evaluation; review and evaluate the performance, accomplishments and effectiveness of OHIP policies in order to advise the Commissioner and Medicaid Director of OHIP effectively; manage a large organization of professional staff.

Conditions of Employment:

Full-time, M-F. Hours consistent with operational needs.

Some positions may require additional credentials or a background check to verify your identity.

Application Procedure:

Submit resume and cover letter, preferably in PDF format, to resume@health.ny.gov, or by fax to (518) 473-3395 with Reference Code SC/HPD3/88006 included in the subject line of your email or fax, or by regular mail to Human Resources Management Group, SC/HPD3/88006 Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012.  Failure to include the required Reference Code may result in the delay of processing your application.

Clipped from: https://www.monster.com/job-openings/health-program-director-3-albany-ny–7b22cfb4-f95c-41d2-922d-4fd592b3fc9d?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

American Cancer Society Washington, DC

Senior Director, State & Local Campaign – Medicaid

+ Job ID: 28656

+ Functional Area: Advocacy

+ Position Type: Full-Time Exempt

+ Experience Required: More than 10 years

+ Location:

District of Columbia – Washington

+ Department: Advocacy

+ Education Required: Bachelors Degree

+ Relocation Provided:

Email a Friend Save Save Apply Now

Position Description:

The American Cancer Society Cancer Action Network (ACS CAN) is the nation’s leading cancer advocacy organization. Together with our charitable partner, the American Cancer Society, we work in Congress, state legislatures and local jurisdictions to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. Based in Washington, DC with offices throughout the country, ACS CAN works to encourage elected officials and candidates to make cancer a top national priority.

The Senior Director, State and Local Campaigns Medicaid directs and manages team to provide issue and campaign expertise supporting the development and execution of comprehensive state and local public policy campaigns with an emphasis on Medicaid policy. The position also leads a cross-functional team to executing multi-year, multi-million-dollar grant funding streams focused on Medicaid public policy, education, and patient stories. This position actively represents ACS CAN with internal and external stakeholders and partner organizations including identifying and forming new strategic partnerships, presenting at multigroup convenings and speaking to the media. The position will drive high-level public policy advocacy strategies nationally in collaboration with ACS CAN senior leaders to be executed at the state and local government levels. From conception to execution, this position will drive ACS CAN advocacy including analyzing legislation, providing guidance and strategic direction. Utilize best practice programs and create new support resources to achieve and support state Medicaid and other policy issue advocacy strategies for issue portfolio. Direct supervision of team of 4-9 people.

Partner with ACS CAN field and regional staff to identify and execute campaign opportunities, resources and trainings needed to be successful. Identify opportunities and participate in ACS CAN fundraising opportunities and funder engagement.

MAJOR RESPONSIBILITIES

+ Serve as Medicaid policy issue and campaign subject matter.

+ Direct national Medicaid program and campaign team to affect state outcomes through state and local legislative and ballot initiative victories working closely with ACS and ACS CAN staff in affected states.

+ Direct Medicaid project grant and direct execution of project deliverables and reporting.

+ Liaise with foundation program officer and other donors in coordination with Vice President State and Local Campaigns.

+ Hire, direct and manage consultants and internal project/campaign teams as well as legislative/campaign and grant budgets for nationwide projects including the Medicaid project budget and contracting process and compliance.

+ Lead cross-functional ACS CAN national, regional and field staff Medicaid team to ensure project deliverables are met. 1) develop, revise and execute organizational workplan 2) organize and facilitate meetings, 3) create and execute timeline, chart of responsibilities, and other managerial tools; 4) create and execute internal and external reporting schedule and mechanism.

+ Recommend organizational strategies and participate in senior management decision making around issue portfolio.

+ Edit and ensure that all required compliance reports are submitted in a timely fashion.

+ Support and direct the creation and management of a strategic plan and resources to support and forward state/local legislative and regulatory strategy for assigned team issue portfolio and the Medicaid grant.

+ For assigned issue portfolio, monitor and analyze all relevant policy issues and provide oral and written analysis, strategic guidance, and support to ACS CAN leadership, regional, field division and other relevant ACS CAN and ACS staff.

+ Provide strategic issue and campaign best practice strategic leadership, guidance and consultation on state and local issue portfolio legislative and ballot campaigns as well as input on regulatory efforts to ACS CAN field staff, volunteers and ACS staff.

+ Actively serve as an ambassador for the Society and ACS CAN with external and internal partners as required, demonstrating the values and reputation of the enterprise and its brand with elected officials and other key audiences.

+ Represent ACS CAN as a participant in national coalitions, elected officials and the media to advance assigned issue portfolio to make linkages that advance ACS CAN policy priorities., including identifying potential new national coalition partners and alliance development partners.

+ Represent ACS CAN by making external and internal presentations/speaking engagements as appropriate to large and small audiences.

+ Identify potential new national coalition partners and alliance development partners.

+ Support and create resources for assigned issue portfolio internally and externally for ACS CAN for all 50 states, the District of Columbia, Guam and Puerto Rico.

+ Provide reports on state and local legislative, initiative, and regulatory efforts for issue portfolio to be used in presentations, to guide policy decisions, to inform leadership of policy progress, etc.

+ Anticipate public policy and regulatory challenges, identify trends and recommend path to drive ACS CAN policy development including creation of tools and materials to provide nationwide support and guidance for field staff and volunteers.

+ Work with ACS CAN policy, media, grassroots, training and federal team staff to coordinate advancement of strategic leadership role for the issue portfolio including execution of the Medicaid grant.

+ Follow ACS CAN policies and guidelines and comply with all related requirements and regulations including compliance with laws, rules and lobby registration/ reporting and federal tax law as applicable.

+ Other duties as assigned.

Position Requirements:

Bachelor’s Degree in political science or related field, or equivalent combination of education and experience required. Minimum of 15 year’s relevant work experience.

SPECIALIZED TRAINING OR KNOWLEDGE:

+ Demonstrated experience in developing new program initiatives and leading/managing staff and volunteer leadership programs.

+ Familiarity with or willingness to be trained on Direct Action Organizing training model.

+ Proven ability to lead by example and motivate others a must.

+ Knowledge of legislative language, processes and public policy implications.

+ Policy and issue campaign experience required.

+ Medicaid policy and health policy issues knowledge required.

+ Demonstrated experience developing funding proposals and grant management.

Skills:

+ Excellent written, oral, interpersonal and computer skills required.

+ Ability to work independently with minimum direction.

+ Demonstrated ability to operate in situations that may have limited or no precedent requiring new concepts or approaches without guidance from others.

+ Demonstrated ability to work on fast-paced, time-sensitive matters with internal and external constituents.

+ Displays the highest level of critical thinking and analysis in bringing successful resolution to high-impact and complex public policy efforts.

+ Makes prompt, sound decisions when faced with complex and often contradictory alternatives that result in successful outcomes

+ Ability to establish and maintain effective working relationships with diverse individuals and communities.

+ Ability to complete work in a timely and efficient manner and ensure work is accurate.

+ Ability to utilize available technology to perform position responsibilities.

Frequent travel required and willingness to travel on short notice a must including some weekends and overnights. Estimated up to 50%.

ACS CAN provides staff a generous paid time off policy; medical, dental, retirement benefits, wellness programs, and professional development programs to enhance staff skills. Further details on our benefits can be found on our careers site at: jobs.cancer.org/benefits. We are a proud equal opportunity employer.

 
 

Clipped from: https://www.ziprecruiter.com/c/American-Cancer-Society/Job/Senior-Director,-State-&-Local-Campaign-Medicaid/-in-Washington,DC?jid=789cfb6600aa2276&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Summary


This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare, Division within the Medicare Drug Benefit and C&D Data Group(MDBG).


As a HEALTH INSURANCE SPEC, GS-0107-13, you will perform a wide range of special ad hoc projects to support policy and/or program oversight related to Medicare Advantage and Medicare Drug Benefit programs.


Responsibilities

• Develop, implement, and maintain operational requirements, including standard operating procedures, as well as databases to manage and analyze programmatic information such as routine and ad hoc report, deliverables, and programmatic documentation.
• Respond to routine inquiries regarding program operations and policies to a variety of internal and external stakeholders (e.g., beneficiaries, providers, representatives of public and private organizations, and other government organizations).
• Apply evaluation skills to proposed program changes to determine organizational impact on operations.
• Provide data in the form of charts, reports, and graphics to leadership to facilitate informed decision-making.
• Work with other CMS staff and stakeholders, either as a member of a project team or as a project lead, to develop methods for innovative approaches for determining and assuring the reliability and validity of data.
  
  

Travel Required


Occasional travel – You may be expected to travel up to 5% for this position.


Supervisory status


No


Promotion Potential


13

• Job family (Series)
• 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-13 , 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: 1. Developing, implementing, and maintaining operational requirements related to Medicare Advantage (Part C) and Medicare Drug Benefit (Part D) programs. 2. Working as a project lead or a member of a project, to develop methods for determining and assuring data integrity. AND 3. Developing project plans to ensure logistics are handled efficiently.


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


Education


This job does not have an education qualification requirement.


Additional information


Bargaining Unit Position: Yes


Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required


Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. 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


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.


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.
• 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.
• Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing.  

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


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):

• Oral Communication
• Project Management
• Technical Competence
• 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.


Background checks and security clearance


Security clearance


Drug test required


No


Position sensitivity and risk


Trust determination process

• Required Documents
  
  

The Following Documents Are REQUIRED

• 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:
• 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.
  
  

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.

• Benefits
  
  

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.


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 to Apply
  
  

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 07/08/2021 to receive consideration.


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


Please Ensure EACH Work History Includes ALL Of The Following Information


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes.

• 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 (


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 janet-marie.wilkinson@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


CMS employees who are currently appointed under Schedule A authority and are interested in applying for this position must submit their resume, Schedule A documentation, transcripts (if positive education required or qualifying through education substitution), and cover letter (optional) to janet-marie.wilkinson@cms.hhs.gov. You MUST include the Job Announcement Number in the subject line of the email to receive consideration for the position. For additional information regarding Schedule A authority


Agency contact information


Janet-Marie Wilkinson


Email


Address


Center for Medicare


7500 Security Blvd


Woodlawn, MD 21244


US


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,07/08/2021, you may check your status online by logging into your USAJOBS account (

• Fair & Transparent
  
  

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


Equal Employment Opportunity Policy


The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.


Reasonable Accommodation Policy


Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.


A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits.


Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when:

• An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job.
• An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace.
• An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events.
  
  

You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis.


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Legal and regulatory guidance


This job originated on

Clipped from: https://www.linkedin.com/jobs/view/health-insurance-spec-at-centers-for-medicare-medicaid-services-2629854411/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description


SHIFT: Day Job


SCHEDULE: Full-time


Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.


This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.


This is a work from home position. Ideal candidate would be able to work PST hours.

Primary Duties May Include, But Are Not Limited To


The Medicaid State Operations Analyst role is responsible for researching, analyzing, documenting and coordinating the resolution of escalated and/or complex claims issues for the Health Plan and requires expert knowledge of all systems, tools and processes.

• Receiving and responding to state or federal regulatory complaints related to claims.
• Managing health plan dispute escalations.
• Quality review of various dispute outcomes.
• Managing complex system issues.
• Managing state updates.

 
 

Qualifications

• Requires a BA/BS; 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience, which would provide an equivalent background.

 
 

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.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-state-ops-analyst-at-anthem-inc-2629030894/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Requisition No: 406123
Agency: Office of the Attorney General
Working Title: MEDICAID FRAUD ANALYST II – 41001293
Position Number: 41001293
Salary: $32,697 – $37,000
Posting Closing Date: 07/09/2021
This is a Full-Time Position
VETERAN’S PREFERENCE
Persons applying claiming veteran’s preference eligibility for this position must complete (in its entirety) in People First and attach to their application in People First the following: 1.) Veteran’s Preference Certification form 2.) Supporting Documentation for Category you are claiming. FAILURE TO COMPLETE AND ATTACH THE NECESSARY FORM AND SUPPORTING DOCUMENTATION BY THE CLOSE OF THE VACANCY ANNOUNCEMENT WILL RESULT IN VETERAN’S PREFERENCE NOT BEING APPLIED. You will need to: 1) print these forms, 2) manually complete the forms, 3) scan the completed forms, 4) save the completed forms, then 5) attach the completed forms to your profile in People First.
If you are having trouble attaching your completed forms to your profile contact our HR office at 850-414-3900.
INTRODUCTORY STATEMENT: The Office of the Attorney General, Department of Legal Affairs (OAG) is a pre-eminent, constitutional office, which serves as the chief lawyer to all state agencies and provides legal protections for Floridians against fraud and through the enforcement of the state’s laws. The OAG, is a cabinet agency in the executive branch of Florida state government.
IMPORTANT NOTICE: To be considered for the position all applicants must:
Submit a complete and accurate application profile necessary for qualifying, such as dates of service, reason for leaving, etc. In addition, all applicants must ensure all employment and/or detailed information about work experience is listed on your application (including military service, self-employment, job-related volunteer work, internships, etc.) and that gaps in employment are explained. Applicants who do not provide all information necessary to qualify, will not be considered for this position.
Verify that applicant responses to qualifying questions are verifiable by skills and/or experience stated on the employment application and/or resume. Applicants who do not respond to the qualifying questions will not be considered for this position.
The elements of the selection process may include a skill assessment exercise.
Current and future vacancies may be filled from this advertisement for a period of up to six months. Following the six-month period, a new application must be submitted to an open advertisement to be considered for that vacancy.
OAG employees are paid biweekly. All state employees are required to participate in the direct deposit program pursuant to s. 110.113 Florida Statutes.
MINIMUM REQUIREMENTS: A bachelor’s degree from an accredited college or university and one year of professional experience in research, investigations, investigative analysis or statistics. Professional or nonprofessional experience as described above can substitute on a year-for-year basis for the required college education.
Preference will be given to candidates who have experience compiling and analyzing investigative information; and experience in the use of spreadsheets and relational database applications.
SKILLS VERIFICATION TEST All applicants who meet the screening criteria/minimum job requirements will be required to take a timed Skills Verification Test. Applicants must receive a score of at least 70% to move to the interview phase.
JOB SUMMARY: This position is in the Medicaid Fraud Control Unit.


Ksa/Examples Of Work Performed


An employee in this position provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. An employee in this position also performs work conducting detailed research and analysis of investigative information relating to alleged violations of applicable laws pertaining to health care fraud, in the administration of the Medicaid program, and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program. An employee in this position may also perform as lead analyst on specialized complex civil enforcement investigations and litigation matters and analytical projects.
35 % Create customized downloads from on-line Medicaid claims data warehouse as requested by investigators, attorneys, and multistate investigative and litigation teams.
25 % Prepare reports/schedules/charts pertaining to all aspects of the analysis and research for use in criminal prosecution, civil actions and administrative referrals.
20 % Assists and supports Medicaid fraud investigators and attorneys in the compilation and analysis of investigative information and the development of damages models for use in Florida specific and multistate health care fraud investigations and litigation. Obtains and analyzes large amounts of data to: interpret and summarize health care fraud activity, calculate damages sustained to the Florida Medicaid program, determine significance, completeness and usefulness of data, recognize and identify patterns and trends, and brief investigators and attorneys.
10 % Extract information from investigative databases. Compile, analyze and disseminate intelligence information retrieved from various computer databases/systems. Perform various duties related to computers.
5 % Assist in the prosecution of Medicaid fraud and/or patient abuse to include testimony in courts of law pertaining to the investigation.
5 % Other duties as assigned.
OTHER REQUIREMENTS: Experience in compiling and analyzing investigative information to include financial and/or statistical data. Experience in creating reports based on information analyzed for use in criminal, civil, and administrative proceedings. Must have strong computer knowledge in the use of spreadsheet and data base applications.
VETERAN RECRUITMENT STATEMENT: The OAG values the service provided by veterans and their families and supports the hiring of returning service members and military spouses. Applicants eligible for veterans’ preference will receive preference in employment and are encouraged to apply, pursuant to chapter 295, Florida statutes. However, applicants claiming veterans’ preference must attach supporting documentation with each application submission that includes character of service (for example, dd form214 member copy #4) along with any other documentation as required by rule 55a-7, Florida administrative code. All documentation is due by the closing date of the vacancy announcement. For information on the supporting documentation required, click here . If you have trouble attaching the documentation, contact our HR office at 850-414-3900.
PERSONS WITH DISABILITY/ADA STATEMENT: The OAG supports the employment of individuals with disabilities and encourages them to seek employment within our agency. If you need an accommodation because of a disability, as defined by the Americans with Disabilities Act, in order to participate in the application process, please notify the people first service center at 877-562-7287. If you need accommodation during the selection process, please notify the hiring authority in advance to allow sufficient time to provide the accommodation.
CRIMINAL BACKGROUND CHECKS/ DRUG FREE WORKPLACE: All OAG positions are “sensitive or special trust” and require favorable results on a background investigation including fingerprinting, pursuant to s. 110.1127(2)(a), F.S. The State of Florida supports a Drug-Free Workplace, all employees are subject to reasonable suspicion or other drug testing in accordance with section 112.0455, F.S., Drug-Free Workplace Act.
We hire only U.S. citizens and those lawfully authorized to work in the U.S.
E-VERIFY STATEMENT: The Office of the Attorney General participates in the u.s. government’s employment eligibility verification program (e-verify). E-verify is a program that electronically confirms an employee’s eligibility to work in the united states after completion of the employment eligibility verification form (i-9).
REMINDERS: Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from SSS. For more information, please visit the SSS website at: https: //www.sss.gov.
If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.
VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.
Nearest Major Market: Orlando

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-fraud-analyst-ii-41001293-at-florida-department-of-transportation-2618769231/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description:

Description SHIFT: Day JobSCHEDULE: Full-timeSupports a single operations department by participating in project and process work. Primary duties may include, but are not limited to: Research operations workflow problems and system irregularities; develops tests, presents process improvement solutions for new systems, new accounts, and other operational improvements; develops and leads project plans and communicates project status . Qualifications Requires a BA/BS degree and 5 years of experience including 3 years of progressively responsible audit experience, leadership experience or any combination of education and experience which would provide an equivalent background: Proficiency in WGS, NASCO, and Facets ACES and CS90 experience also preferred Proficiency in Commercial and Medicare Working knowledge of COB prevention, data match, claims edits and inquiries team processes Strong verbal and written communication skills Proficiency in Coordination of Benefits experience, which includes detailed working knowledge of NAIC guidelines, CMS primacy rules, and claim coordination methodology Basic understanding of statistics; thorough understanding of different audit methodologies, in-depth knowledge of multiple systems and proven understanding of processing principles, techniques and guidelines; excellent organizational, project management, analytical, leadership, verbal and written communication skills required. REQNUMBER: PS52327

14 hours ago

 
 

Clipped from: https://us.trabajo.org/job-640-20210701-ef1045f7bdb3501824c46c92e5262080?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

We’ve made a lot of progress since opening the doors in 1942, but one thing has never changed – our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

This job is responsible for identifying opportunities and promoting cost and quality improvement across the organization’s suite of value-based contracts. This job provides focused direction and promotion of programs including the Medicaid Managed Care Incentive Program (MCIP), navigating across the numerous facets of the company, its health network participants, government agencies and external stakeholders.


Education

Required – Bachelor’s degree in Business Administration, Finance, Economics, Healthcare or related field


Preferred – Master’s degree in Health Administration, Business Administration or related field


Work Experience


Required – 5 years’ program or personnel management experience in a large healthcare organization.


Knowledge Skills And Abilities (KSAs)

• Must be able to drive change working across varied departments and organizations
• Strong skills sharing visions and generating results.
• Must be able to manage vendor relationships related to the role.
• Must be able to create financial models and budgets.
• Strong skills developing and executing strategic initiatives and driving performance through alternative payment models or clinical integration.
• Must have strong verbal and written communication skills to effectively flex the style and content to reach varied audiences.
• Strong computer skills and working knowledge of software, including salesforce, Microsoft office, tableau, etc.
• Working knowledge of changing research, regulations and bills.
• The ability to decipher large amounts of information and make strategic decisions.
  
  

Job Duties

• Directs the translation of clinical and financial data into action plans and accountability initiatives across the network.
• Works with practices, regions, and service line leaders to determine opportunities for cost and quality improvement under Value Based agreements.
• Establishes substantial integration across departments including analytics, IS, legal & compliance.
• Acts as a liaison to LDH for MCIP participants to mitigate the significant regulatory, financial and operational risk of MCIP participation.
• Oversees the research, modeling and applications for continued participation and/or new contracts or program opportunities for our beneficiaries.
• Assumes fiscal responsibility of the annual operating budget and establishes processes to track quality, cost and utilization within the program
• Effectively communicates innovations within the programs to drive results and achieve shared savings.
• Other related duties as required.
   

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical essential functions of this job include (but are not limited to) the following: Frequently exerting 10 to 20 pounds of force to move objects; occasionally exerting up to 100 pounds of force. Physical demand requirements are in excess of those for sedentary work. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Are you ready to make a difference? Apply Today!

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or careers@ochsner.org . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

 

Clipped from: https://www.linkedin.com/jobs/view/director-of-aco-programs-medicaid-at-ochsner-health-2618707777/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic