Medicaid Conversations: Pharmacy Carve-outs and 340B chat with Leslie Latano-Saba
Author: MM_ADMIN
Berry, Dunn, McNeil & Parker LLC Staff Consultant, Medicaid Job in Portland, ME | Glassdoor
Overview:
BerryDunn is seeking a Staff Consultant for BerryDunn’s Medicaid Practice Area within our Government Consulting Group. Our Medicaid Practice Area focuses on supporting decision makers in state Medicaid agencies throughout the country in the design, development, financing, implementation, and evaluation of their Medicaid programs. In order to do this, our team applies our knowledge and skills in the areas of, federal policy and legislative analysis, Medicaid program design and development, and information systems technology. Serving as trusted advisors, our contributions allow policymakers and institutions to focus on their objectives with the information and tools they need to make the right decisions to achieve their program goals. The culture at BerryDunn is collegial, collaborative, and mutually supportive. Currently, our team is engaged with Medicaid projects at different stages with focus on Medicaid policy development, system implementation, and program transformation. As a result, we are looking for interested, qualified professionals to join our growing team as a Staff Consultant. You would be reporting to senior members of our Medicaid Practice Area and would have experience or relevant coursework with government, public policy, healthcare, and/or the Medicaid program. You will work out of our Portland, ME office. The start date for this role will be in July of 2021.
Travel Expectations: Willingness to travel 35-50% (While 35-50% of travel is a requirement of the role, due to COVID-19, non-essential travel has been temporarily suspended.)
Responsibilities:
You will:
- Assist in providing consulting services to clients under the supervision of more experienced consultants.
- Follow appropriate diagnostic, data collection, fact-finding, and data analysis practices.
- Assist in conducting research, assisting with detailed and technical aspects of the engagement, documenting the engagement and assisting with engagement reporting.
- Perform assigned administrative tasks.
- Develop concise summaries, reports, and presentations of complex data for client leadership.
- Facilitate meetings and interviews with client stakeholders.
- Assist with project management tasks such as tracking and reporting project progress, maintaining project document repository, and reviewing deliverables for quality assurance.
- Provide ad hoc assessments and briefings in response to client requests.
- Continue to grow professionally through a program of self-development and formal continuing professional education programs.
- Participate/Support firm-wide initiatives, including new business development.
- Work toward obtaining appropriate professional certifications.
- We encourage involvement in civic and professional activities.
Qualifications:
Our Benefits:
We value our employees and offer a variety of attractive benefits, in addition to being part of a high-powered, effective team! Here are just a few of our attractive benefits:
- Health, Dental, Rx and Vision Insurance
- Health Savings Account (HSA); Employer contribution
- Responsible Paid-Time-Off policy, including Paid Family Leave
- 401(K) profit sharing plan with employer match after one year
- Life and AD&D Insurance
- Long-term Disability Insurance
- Long-term Care Insurance
- Tuition Reimbursement, Continuing Professional Education, and CPA Exam
- Wellness Programs
- Mentor Programs
About BerryDunn:
BerryDunn is a CPA and Management Consulting firm with over 500 employees throughout the country that provide a full range of services including Management and IT Consulting, Health Analytics/Actuarial Consulting, Audit, Accounting, and Tax. We are headquartered in Portland, Maine, with offices in Arizona, Connecticut, New Hampshire, and West Virginia. BerryDunn has maintained steady growth over its 40+ year history, and the firm is regularly named to national “Top 100” lists, including recent recognition for being a “fastest-growing” firm. We partner with clients across the United States and Canada, and we attribute our growth to attracting, developing, and retaining outstanding employees who help our clients create, grow, and protect value.
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.
Pharmacy Business Analyst – Medicaid Job Arkansas USA,Healthcare Pharmaceutical jobs
Pharmacy Business Analyst – Medicaid
Full Time Permanent Role
Conway, Arkansas
- Management of procedures associated with systems change orders
- Ensure the integrity of pharmacy data used in claims processing
- Management of requests for claims adjustments
- Informational resource for call center staff
- Informational resource pertaining to inquiries, system configuration, and data files
- Support and back-up of Account Pharmacy Services Director and PBM Operational Account Manager as appropriate
Minimum Qualifications:
- Extensive knowledge of Medicaid claims processing, data management, pharmacy practices, and the Nevada Medicaid program
Preferred Qualifications:
- Nationally Certified Pharmacy Technicians (certified through PTCB) and licensed in the State of Nevada
Clipped from: https://www.learn4good.com/jobs/arkansas/healthcare/237083724/e/
Location: Center Ridge
Medical Director Medicaid job in TEMPLE, Texas, United States | Physicians jobs at Baylor Scott & White Health
The Medical Director will be responsible for managing health plan medical costs and assuring appropriate health care delivery for plans and members. They will be responsible for leading the organizations efforts to achieve excellence in healthcare affordability, quality, member experience, and improved population and member outcomes. They will serve as a clinical leader for teams dedicated to concurrent review, prior authorization, case management and clinical coverage review.
– Share the health plan’s passion for evidence-based medicine and be comfortable applying evidence-based guidelines. Collaborate with other senior leaders in efforts that enhance the quality of care delivery, improve outcomes, and improve value delivered to our members.
– The Medical Director can expect to perform the following functions:
– Support pre-admission review, utilization management, concurrent and retrospective review process and case management.
– Provide professional leadership and direction in the utilization/cost management (UM) and clinical quality improvement (QI) of the health plan, as measured by benchmarked UM and QI goals.
– Work collaboratively as a clinical resource to other plan functions that interface with medical management such as provider relations, member services, benefits, claims management, etc.
– Ensure members receive safe, effective, equitable, efficient, timely and patient-centered health care services within their health plan benefits.
– Carry out medical policies at the health plan consistent with NCQA and other regulatory bodies.
– Participate and/or chair clinical committees and work groups as assigned.
– Review medical care, medical service, and pharmacy requests against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
– Identify potentially unnecessary services and care delivery settings, and recommend alternatives, as appropriate.
– Review appeals of medical and pharmacy denials against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
– Identify opportunities for corrective action plans to address issues and improve plan and network managed care performance.
– Collaborate with Provider Networks and Medical Director team in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
– Participate in the retrospective review and analysis of plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs, and other sources.
– Provide periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual QI Work Plan.
– Assure plan conformance with legal and regulatory requirements; support NCQA qualification activities, including site visits and response to accrediting and regulatory agency feedback.
– Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.
– Conduct quality improvement and outcomes studies as directed by the state and federal regulatory agencies, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee, and management.
– Support grievance process, as led by Chief Medical Officers, ensuring a fair outcome for all members.
– Monitor member and provider satisfaction survey results and implement changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
– May be asked to chair various health plan committees, such as Quality Management subcommittees on Peer Review or Credentialing.
– Promote wellness and ensure programs of prevention, education and outreach to members and providers consistent with the company’s Mission, Ambition, and Values
– Perform and oversee in-service staff training and education of professional staff.
– Contribute to the development of strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies.
– Participate in key marketing activities and presentations, as necessary, to assist the marketing effort.
Account Executive (Behavioral Health/Medicaid) job in San Diego, California, 92108 | Sales jobs at Magellan Health
Manages the day to day account relationship. Supports the development of and executes on ongoing strategy to ensure retention and growth by providing solutions that align with customer`s overall business and human capital management objectives. Develops strong relationships with internal matrix partners that support achievement of strategic alignment (IT, Finance, Product Development, Claims, Legal etc.). Under guidance, takes the leadership role in coordinating these resources to achieve business objectives, maintain account satisfaction, and ensures that the company’s products and services support customer`s needs.
Seeking candidates with account management experience in behavioral health or MediCal (Medicaid). Candidate must reside in the California market area.
·Customer Relationship: Supports the account management team in developing and maintaining a strategic business plan that fully reflects global customer’s business objectives and how the company’s solutions align with those objectives and specifically guides the company’s operational, financial, network, clinical and relationship initiatives.
·Understands the customer’s structure and demonstrates the ability to apply this knowledge in business and retention planning for the client.
·Ensures Service Level Agreement performance, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis and adherence to requirements of the account?s legal/regulatory environment.
·Owns overall account satisfaction within the company as well as satisfaction with all specific areas particularly account management.
·Develops strong relationships which penetrate the customer at various levels from day to day contacts to senior leadership involving other internal staff to maintain multiple connections and strengthen the overall relationship.
·Develops strong relationships and contacts within the company that are supportive of the achievement of customer service requirements including attainment of performance guarantees and minimization of performance penalty expense.
·Ensures all Customer and Account-Facing services are provided in a consistent and timely fashion.
·Supports the Internal Customer Operating Model.
·Resolves or appropriately escalates customer service issues in conjunction with operations (claims, service, and systems).
·Provides mentoring to the account management team in effective problem solving and servicing of the account.
·Develops, introduces, and executes the customer governance process.
·Builds relationships and alliances with matrix partners.
·Compliance: Coordinates with the compliance department on knowing and understanding regulations and the implication to customer impact.
·Maintains a client audit schedule to ensure a proactive approach in supporting critical client compliance.
·Coordinates all customer audit preparation and execution.
·Proactively communicates to internal and external contacts.
·Demonstrates thorough contract understanding and detailed knowledge of business requirements.
·Coordinates with legal to ensure contract compliance.
·Reporting: Defines customer reports and ensure coordination with the client.
·Oversight of reporting calendar to ensure timely submission.
·Analyzes data and reporting and executive summary development.
·Prepares and supports presentation of customer reports with meaningful analytics, trending and recommendations for program improvement based on findings.
·Ensures all client reports have an executive summary and explanation of data.
·Financial: Ensures revenue goals are met, cost of care and administrative expenses are managed and segment profit targets are achieved for assigned account (s).
·Demonstrate a thorough knowledge of Cost of Care and implications internally and for the client.
·Ensures performance standards are measurable and realistic to achieve and/or exceed to avoid penalties. Partners with Operations and Network on monitoring. Manages methodology, reporting and communications.
·Directly participates and supports manager on all renewal activities.
·Manages risks and develop opportunities associated with underwritten rates.
·Up-Sell/Product/Growth: Analyzes account benefit and ability to apply this knowledge to growth.
·Drives up-sell and renewal activities across assigned account(s). Negotiates and/or supports negotiation of rates and contractual terms with customers that result in achieving segment profit targets and creatively adjusts features and service delivery models that increase efficiency and improve value to the customer and/or margin for the company.
·Identifies products and services that bring solutions to the customer based on a thorough understanding of the customer’s strategic business goals and the business needs.
·Demonstrates depth of knowledge of the company’s products and how multiple products are interdependent within the customer contract deliverables and outcomes.
·May oversee staff as appropriate.
Other Job Requirements
Responsibilities
- Proficient in MS Office suite.
- Excellent verbal and written communication skills.
- 7+ years’ relevant experience.
- If degree requirement not met, will consider with 10 years of experience.
General Job Information
Title
Account Executive (Behavioral Health/Medicaid)
Grade
27
Work Experience
Account Management
Education
Bachelors
License and Certifications – Required
License and Certifications – Preferred
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
Social Worker – Medicaid Care Management – Greenville, NC in Greenville, NC – Vidant Health
Job ID: 948586
Facility: Access East, Inc
Location: Greenville, NC
FT/PT: Full-Time
Reg/Temp: Regular
Date Posted: Feb 18, 2021
Job Description
Vidant Health
About Vidant Health
Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.
Position Summary
The Social Worker (SW) coordinates the delivery of care across the continuum and social work services to all inpatient and observation units of the hospital and designated outpatient and ambulatory treatment units. The SW provides collaboration and oversight in complex clinical issues to Nurse Care Managers (RN CM) and Discharge Coordinator (DC) staff. This role requires interaction with a variety of patient populations including, but not limited to, neonatal, pediatric, adolescent, adult, geriatric and behavioral health.
Provides advanced practice social work services related to patients’ and family members’ current and post-acute psychosocial and clinical needs. Completes psychosocial assessments; provides crisis intervention, emotional support, and short-term counseling with regard to diagnosis, treatment, and cross continuum care plans; and creatively identifies and accesses resources to optimize effective and efficient patient care outcomes in collaboration with other members of the – interdisciplinary team.
The SW is accountable for the management of identified complex care planning and social work functions for
assigned patient care area using advanced social work theory and advanced clinical practice skills appropriate to the age of the patient incorporating the patient/family’s social and emotional state. Utilizes principles of individual, group and family therapy theories.
Proactive development, implementation and ongoing revision of an interdisciplinary plan of care. Negotiation and collaboration with the interdisciplinary team, community resources and payers to facilitate timely and cost effective care plans that enhance appropriate health and social services in the continuum of care are imperative.
Minimum Requirements
- Required Masters of Social Work degree from a CSWE accredited school of social work is required
- CPR training within one year of hire is required
Preferred Requirements
- 2 years of recent experience as a social worker in a health-related environment. Licensed
- Clinical Social Worker/Licensed Clinical Social Worker Associate Certification in Case Management.
Other Information
- Monday – Friday 8:00 – 4:30 pm
- Initial 90 day orientation will be onsite in the Greenville Access East office location
- Position will evolve into rotating days in the office, in a practice clinic, and remote work from home
- Future home visits will begin after COVID restrictions are lifted
General Statement
It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
MEDICAID PROGRAM MANAGER 1–A | Government Jobs
Job Details
MEDICAID PROGRAM MANAGER 1–A
This listing closes on 3/12/2021 at 11:59 PM Central Time (US & Canada).
Salary $26.71 – $52.56 Hourly $4,630.00 – $9,110.00 Monthly
$4,630.00 – $9,110.00 Monthly
Location Baton Rouge, LA
Baton Rouge, LA
Job Type
Classified
Department
LDH-Medical Vendor Administration
Job Number
MVA/SAG/1980
Closing date and time
3/12/2021 at 11:59 PM Central Time (US & Canada)
Supplemental Information
Job Number: MVA/SAG/1980
This position is located within the Louisiana Department of Health l Medical Vendor Administration l Medicaid Enterprise Systems (MES) l EBR Parish.
Cost Center: 0305-7103
Position Number(s): 50382733
This vacancy is being announced as a Classified position and may be filled either as a Probationary Appointment, Job Appointment or Promotional Appointment.
(Job Appointments are Temporary Appointments up to 48 months)
****REVIEW YOUR APPLICATION TO MAKE SURE IT IS CURRENT. Failure to provide your qualifying work experience may result in your application not being considered.****
There is no guarantee that everyone who applies to this posting will be interview. The hiring supervisor/manager has 90 days from the closing date of the announcement to make a hiring decision. Specific information about this job will be provided to you in the interview process, should you be selected.
No Civil Service test score is required in order to be considered for this vacancy.
To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*
For further information about this vacancy contact:
Sanaretha Gray @ Sanaretha.Gray@la.gov
LDH/HUMAN RESOURCES
P.O. BOX 4818 BATON ROUGE, LA 70821
225 342-6477
Qualifications
MINIMUM QUALIFICATIONS:
A baccalaureate degree plus four years of professional experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.
SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.
Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:
A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.
30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.
College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.
Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; public relations; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.
A master’s degree in the above fields will substitute for one year of the required experience.
A Juris Doctorate will substitute for one year of the required experience.
Graduate training with less than a Ph.D. will substitute for a maximum of one year of the required experience.
A Ph.D. in the above fields will substitute for two years of the required experience.
Advanced degrees will substitute for a maximum of two years of the required experience.
NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.
Job Concepts
Function of Work:
To administer small and less complex statewide Medicaid program(s).
Level of Work:
Program Manager.
Supervision Received:
Broad from a higher-level manager/administrator.
Supervision Exercised:
May provide functional supervision in accordance with the Civil Service Allocation Criteria Memo.
Location of Work:
Department of Health and Hospitals.
Job Distinctions:
Differs from Medicaid Program Monitor by responsibility for administering small and less complex statewide program(s).
Differs from Medicaid Program Manager 1-B by the absence of supervisory responsibility.
Differs from Medicaid Program Manager 2 by the absence of responsibility for administering medium size and moderately complex statewide program(s).
Examples of Work
Supervises the auditing of eligibility enrollment of all Medicaid programs statewide.
Reviews work of eligibility review staff for quality assurance.
Plans, coordinates, and controls small or less complex statewide program(s).
Plans, develops, implements and monitors comprehensive Medicaid program policies.
Conducts and directs studies/special projects pertaining to the programs assigned.
Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.
Reviews and analyzes complex data and system reports to ensure compliance with program regulations.
Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.
Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.
Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.
Identifies, verifies and analyzes the various revenue sources for the program(s). Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.
Benefits
Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to “make a difference” through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits and have access to a great professional development program.
Flexible Working Arrangements – The flexibility of our system allows agencies to implement flexible working arrangements through the use of alternative work schedules, telecommuting and other flexibilities. These arrangements vary between hiring agencies.
Professional Development – The Comprehensive Public Training Program (CPTP) is the state-funded training program for state employees. Through CPTP, agencies are offered management development and supervisory training, and general application classes on topics as diverse as writing skills and computer software usage.
Insurance Coverage – Employees can choose one of several health insurance programs ranging from an HMO to the State’s own Group Benefits Insurance program. The State of Louisiana pays a portion of the cost for group health and life insurance. Dental and vision coverage are also available. More information can be found at www.groupbenefits.org.
Deferred Compensation – As a supplemental retirement savings plan for employees, the State offers a Deferred Compensation Plan for tax deferred savings.
Holidays and Leave – State employees receive the following paid holidays each year: New Year’s Day, Martin Luther King, Jr. Day, Mardi Gras, Good Friday, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and Christmas Day. Additional holidays may be proclaimed by the Governor. State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.
Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): Louisiana State Employees Retirement System (www.lasersonline.org), Teacher’s Retirement System of Louisiana (www.trsl.org), Louisiana School Employees’ Retirement System (www.lsers.net), among others. LASERS has provided this video to give you more detailed information about their system.
Agency State of Louisiana Phone (866) 783-5462 Website http://agency.governmentjobs.com/louisiana/default.cfm
Address For agency contact information, please refer to
the supplemental information above.
Louisiana State Civil Service, Louisiana, 70802
Director, Request for Proposal (Medicaid) – REMOTE – Molina Healthcare
Manages entire process of the development and submission of complex, large-scale Medicaid proposals from RFP release to proposal delivery and through any additional protest periods, delegating to and coordinating with Proposal Deputy, as applicable. Responsible for ensuring Molina capabilities and strategic, forward-thinking vision is captured within the response by working with strategic leaders and coordinating the development of strategic direction. Works enterprise-wide to establish excellent working relationships with subject matter experts and coordinates with large-scale teams to ensure proposal success.
Manages and provides development, compilation, editing, and submission of compliant, client-focused, and technically accurate Medicaid proposals. Ensures 100% compliance with proposal requirements; 100% of proposals must be submitted by client-provided deadline. Establishes and maintains a compliant work plan, a proposal schedule, all other proposal documentation, and provides overall RFP analysis. Supports RFP, RFA, and RFI response projects, while contributing to procurement opportunities and development of strategies and content that enhance response quality.
Must have demonstrated experience managing very large and complex bids and experience managing multiple proposals at a time is a plus. Willingness to work extended hours and assist team members in meeting deadlines as necessary. Proofreading skills, acute attention to detail, and ability to handle demanding, deadline-driven situations. Must be very dependable and possess exceptional customer service skills. Serves as a mentor to proposal managers and assists other Directors of Proposal Management, as required, serving as a proxy in his/her absence, as necessary.
Knowledge/Skills/Abilities
* Analyzes RFPs and applies appropriate proposal process and procedures
* Allocates resources, and monitors requirements, deadlines, and assembly/submission
* Researches, analyzes, and coordinates overall strategic vision for proposal compliance and successful messaging
o Defines style conventions based on proposal team standards and the RFP
o Establishes and maintains all proposal documentation (schedule, work plan, etc.)
o Gathers and coordinates discussion and delivery of RFP questions
o Plans and leads meetings (e.g., kick-offs, status meetings, etc.) and all color reviews
* Ensures proposal compliance with RFP and the completion of all required forms
* Assists in the development of executive summaries; writes proposal sections as needed
* Oversees the proposal’s online workspace (SharePoint)
* Coordinates with-and supports-graphics and production efforts
* Reviews and edits all proposal sections, providing ultimate sign-off
* Reviews final document and leads white glove and book check
* Ensures on time production and communicates delivery plan
* May have direct reports
* Other duties as assigned
Job Qualifications
Required Education
Graduate Degree or equivalent combination of education and experience
Required Experience
7-9 years of proposal management or applicable experience
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10 years of proposal management or applicable experience
Preferred License, Certification, Association
Project Manager or Proposal Management certification
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Medicaid Billing Specialist job in Kansas City, Missouri | Ajilon
Description
Medicaid Billing Specialist
Ajilon is assisting with a search for a Medicaid Billing Specialist for a Client in Kansas City, MO. Your primary job duties will be responsible for billing and invoicing for all Medicaid programs as well as monthly, quarterly and annual reports, audits, tracking and drawdowns. Our ideal candidate would have exposure to Medicaid, at least 2 years of medical billing experience and have strong attention to detail and ability to make an appeal if necessary. This role will be on-site following social distancing guidelines with pay starting at $18ph and going up with experience. There are TONS of GROWTH opportunities in this role with potential to manage a team in 1-2 years. Read below for additional details!
RESPONSIBILITIES:
- Responsible for billing, reviewing, and submitting files for the following programs and services: Consumer Directed Services, In Home, Money Follows the Person, HCBS Program, Employment Program, Transportation, and other organizational billings.
- Responsible for importing of the 835 files into the billing software; reconciling billed vs paid claims including Medicaid remittances; resubmitting corrected claims and identifying uncollectible claims.
- Provide staff information regarding billing discrepancies, ineligible claims, and Medicaid eligibility.
- Ensure organization is current and complies with federal and local healthcare regulations, policies, and procedures; disseminates information to staff as needed.
- Completes Quarterly and Annual Reporting for: Missouri Vocational Rehabilitation, Federal Grant, CDS Financials, Home Health Statistical Report, IL Grant application and other reports as needed.
- Responsible for Home Health month-end close; updating HCBS accounts receivable analysis; and Transportation Department analysis
- Responsible for utilization calculations/tracking for Home Health, In-Home & CDS.
- Responsible for Monthly tracking for MFP reimbursable & Employment Invoices.
- Responsible for the drawdown on Federal Grants according to CFO’s instructions.
- Completes various audit reports as scheduled.
- Assists accounting department with special projects as assigned.
QUALIFICATIONS:
- High school diploma, GED or equivalent work experience
- At least 2 years medical billing experience with exposure to Medicaid Billing
- Skilled in the use of computers and the Microsoft Office and excel applications.
- Prior experience with eMOMED and any Medicaid billing software
- Strong organizational skills.
- Great customer and communication skills.
- Works under the pressure of deadlines.
- Ability to follow process procedures.
- Ability to work well with others in a team environment.
- Great attention to detail!
- Strong organizational skills
- Ability to learn quickly
Do you have experience with medical office administration or billing and are looking for an immediate opening? If so, apply now!! Go to www.ajilon.com and submit your resume for consideration.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please click here.
The Company will consider qualified applicants with arrest and conviction records
Senior Analyst, Medicaid ACO
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: Reporting to the Senior Manager of Analytics and in support of the Director of Medicaid ACO, the Senior Analyst serves as the key analytic resource to meet the information, reporting, and analytic needs of Steward Health Care Network (SHCN)’s Medicaid Accountable Care Organization.
- Conducts sophisticated business analyses to support Medicaid ACO program development and ongoing operations, grounded in deep expertise and functionality with both internal and publicly available Medicaid-related health care data sources
- Draft memos and bulletins that summarize key conclusions and findings of impact analyses to inform Steward’s leadership teams
- Analyze and recommend opportunities and financial impacts of strategic partnerships, new Medicaid programs, and key Medicaid ACO related initiatives
- Deliver accurate and on-time deliverables, including reports, cost estimates, models and ad-hoc analyses
- Develop and program comprehensive, timely, and accurate analyses, reports, and presentations on utilization, leakage, risk performance, care management, and quality metrics to support the operation of SHCN’s Medicaid ACO;
- Work with business and operational leaders to identify TME opportunities and quantify ROI for related programs
- Coordinate with Steward’s internal data, analytics, and information technology teams to manage data and reporting related to Medicaid programs
- Identify opportunities to improve and enhance the analysis and information provided to SHCN leadership, participating network providers, and community partner organizations
- Work with analysts and analytic tool vendors to improve standard report design
- Support ad hoc analytic requests, providing accurate and timely data, analysis and insightful interpretations
- Performs other duties as requested
Education / Experience / Other Requirements
Education:
- Bachelor’s degree required, Master’s preferred
Years of Experience:
- 3-5 years of relevant experience in healthcare, analytics, or informatics
Specialized Knowledge:
- Possess strong analytic and technical skills plus an ability to translate complicated data into useable information;
- Ability to work on multiple projects simultaneously, deliver work products on deadline, and respond to new requests with fast turn-around, as needed
- Possess strong skills in SQL, Excel, Access and PowerPoint
- Organizational and project management skills to manage projects effectively;
- Demonstrated knowledge of relationships between health plans and providers, including detailed understanding of health plan data and familiarity with Medicaid and other public programs;
- Possess an in-depth understanding of claims data, including ICD-9 & CPT codes, DRGs, health status and risk adjusters;
- Excellent verbal and written communication skills, including the ability to graphically present complex data; outstanding interpersonal skills; and ability to relate positively with individuals at all levels of the organization
- Creative, flexible, and self-motivated with sound judgment; ability to plan and implement;
- Commitment to service excellence
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.