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I. POSITION SUMMARY:

Responsible for the administration and analysis of State Medicaid contracts including reviewing and validating submissions, processing and paying rebates, and analyzing quarterly utilization and rebate trends and variances. Manages responsibilities in accordance with various state & federal regulations including but not limited to: Section 1927 of the Social Security Act, the Omnibus Budget Reconciliation Act of 1990 and 1993, Section 602 of the Veterans Healthcare Act, and Sarbanes Oxley as well as internal policies and procedures.

II. PRIMARY JOB RESPONSIBILITIES:

 
 

1. CONTRACT ADMINISTRATION/PROCESS REBATES: Review and analyze all contract fields and evaluate contract language to uphold integrity of the rebate processing system. Manage contract changes such as adding/deleting products. Review and analyze pricing in the contract systems; ensure accurate reimbursement in a timely manner; maintain proper contract files; monitor contract expiration report. Process Medicaid rebate Claims within the systems Medicaid Module for Federal Statutory Programs, State Supplemental, and State Pharmaceutical Assistance Programs (SPAPs). Resolve open disputes with states. Work closely with State personnel, internal customers, and finance and rebate teams. Maintain good customer relations.

 
 

 
 

 
 

1. SYSTEM MAINTENANCE: Load/maintain all products, pricing and contract information in the Revitas Medicaid Module; ensure proper set-up, coverage, calculation and reimbursement of all programs & products. Perform system preparation for each quarterly rebate cycle including but not limited to, RPU calculations, new product baseline data, T-Bill rates, CPI-U indexes, calculation methods, etc. Work with internal & external IT support teams on system issues, upgrades and patches. Review, analyze and resolve price discrepancies with CMS and the states; follow-up and correct all issues related to processing claims or system issues.

 
 

 
 

 
 

 
 

1. REPORTS & ANALYSIS: Compile necessary reports needed to support pricing disclosures; document explanations in file. Compile & distribute quarterly sales, trend, and rebate reports to internal and external customers. Use internal systems to compile data necessary to research specific price issues related to internal self-audit or government-initiated audits.

 
 

III. ADDITIONAL JOB RESPONSIBILITIES:

 
 

 
 

 
 

 
 

• STANDARD OPERATING PROCEDURES: Update SOP’s as changes in law, business, systems, or processes dictate. Ensure proper compliance with Sarbanes Oxley controls; submit reports necessary to audit tests.

 
 

 
 

 
 

• FILE MAINTENANCE/DOCUMENTATION: Compile and maintain files for quarterly submissions, contracts, etc.

 
 

Qualifications


IV. POSITION QUALIFICATIONS:


Education: BA/BS, or equivalent experience required


Experience: 2+ years business experience, preferably with a concentration in contracting, and Medicaid related activities or financial analysis


Knowledge, Skills, and Abilities

 
 

 
 

 
 

 
 

1. Strong analytical, problem-solving and organizational skills
2. Proficiency in Microsoft Excel
3. Excellent analytical and organizational skills
4. Ability to manage multiple tasks, priorities and timelines
5. A self-starter who can work independently
6. Functional knowledge of Revitas/Model N and Medicaid systems preferred

 
 

V. PHYSICAL REQUIREMENTS:


While performing the duties of this job, the employee is required to:

 
 

 
 

 
 

1. Communicate effectively with internal and external individuals
2. Use computer, phone and other related business machines
3. Sit for prolonged periods of time
4. Travel to/Attend meetings off company premises

 
 

 Clipped from: https://www.biospace.com/job/2252743/medicaid-analyst/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Department of Health And Human Services

Center for Program Integrity (CPI)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), Division of Program Integrity Support Contracts.

As a Health Insurance Specialist (Program Contractor Management), GS-0107-11/12, you will use program knowledge to effectively plan, identify, and design contract requirements during the planning and awarding phase of acquisition(s).

Learn more about this agency

Responsibilities

• Provide analytical support on policy issues and topics, research background information, the origin of laws, and the intended impact in order.
• Use program knowledge to effectively plan, identify, and design contract requirements during the planning and awarding phase of acquisition(s).
• Document performance with special emphasis on significant trends and items of interest in the management of contractor actions.
• Manage, monitor, and oversee contractor transition activities.
• 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.

Travel Required

Occasional travel – 5% or less

Supervisory status

No

Promotion Potential

12

• Help

Requirements

Conditions of Employment

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

Qualifications

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


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


In order to qualify for the GS-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Monitoring contractors that support in national health care delivery, quality, or payment programs and/or maintain health care program-related databases; (2) Conducting analytical studies by interpreting health care program issues related to contract administration functions; and (3) Coordinating responses to government inquiries regarding health care program issues requiring corrective action plans.


In order to qualify for the GS-11, 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-09 grade level in the Federal government, obtained in either the private or public sector, to include: A. (1) Assisting in monitoring contractors that participate in national healthcare delivery programs and/or maintain program-related databases; (2) Participating as a team member in analytical studies by gathering, organizing, and interpreting policy, program, and/or operational issues related to contract administration functions; and (3) Developing responses to inquiries regarding healthcare program integrity issues.

– OR – B. Substitution of Education for Experience: possess a Ph.D. or equivalent doctoral degree or have completed three full years of progressively higher level graduate education leading to such a degree or I possess a LL.M in a related field of study, from an accredited college and/or university. One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent one year of full-time study. If that information cannot be obtained from the school, 18 semester hours will satisfying the one year of full-time study requirement. (TRANSCRIPT REQUIRED AT TIME OF APPLICATION)

– OR – C. Combination of Experience and Education: combination of specialized experience as described in “A” above and graduate education as described in “B” above. To combine education and experience, determine the total qualifying experience as a percentage of the experience required for the grade level. Then determine the education as a percentage of the education required for the grade level. Finally, add two percentages. The total percentage must equal at least 100 percent.


TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see “Required Documents” section below for what documentation is required at the time of application.

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 or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11032441

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 Office of Personnel Management (OPM) Salaries & Wages Page.


Additional Forms REQUIRED Prior to Appointment:

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

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


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

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How You Will Be Evaluated

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

Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.


Once the announcement has closed, your online application, resume, transcripts 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):

• Contracting/Procurement
• Health Insurance
• Oral Communication
• Written Communication

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Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Non-sensitive (NS)/Low Risk

Trust determination process

Credentialing, Suitability/Fitness

• Help

Required Documents

The following documents are REQUIRED:


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

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, transcripts 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, transcripts and CMS required documents, will result in you not being considered for employment.

• Help

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. Learn more about federal benefits.

Review our benefits

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

• Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 02/25/2021 to receive consideration.


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


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

• Official Position Title (include series and grade if Federal job)
• Duties (be specific in describing your duties)
• Employer’s name and address
• Supervisor name and phone number
• Start and end dates including month, day and year (e.g. June 18, 2007 to April 05, 2008)
• Full-time or part-time status (include hours worked per week)
• Salary

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

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

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


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


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

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Agency contact information

McQuail Price

Email

McQuail.Price@cms.hhs.gov

Address

Center for Program Integrity
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

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


Within 30 business days of the closing date,02/25/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

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• 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.

• Equal Employment Opportunity (EEO) for federal employees & job applicants

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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.

Learn more about disability employment and reasonable accommodations or how to contact an agency.

Read more

 
 

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/592126600

Financial Eligibility Specialist 2

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

Financial Eligibility Specialist 2

AHCCCS

Posting Details:

Salary: $30,909 
 

Grade: 15

Job Summary:

The Division of Member and Provider Services (DMPS) is looking for a highly motivated individual to join our team as a Program Services Evaluator 2 (Grade 15); working title is Financial Eligibility Specialist. This position is located in the Phoenix Long Term Care Office and require the PSE to work in a call center based environment and/or a work management environment depending on the business needs of the office. Both environments require the PSE to provide customer service and process applications, changes and renewals, and have data driven performance measures; and if applicable, call center level reporting and monitoring. PSE will be required to act as a duty worker either telephonically or in the office based on business needs.

Job Duties:

* Gather, verify and update financial information

* Use various computer-based programs to determine financial eligibility of applicants

* Interview customers in-person or over the phone

* Manage a large dynamic caseload with productivity, timeliness and quality measurements

* Starting salary of $30,909/year and the ability to increase salary after 8 months, based on performance

* As part of the selection process, candidates will receive an email request to complete a testing and writing exercise within a required timeframe

Knowledge, Skills & Abilities (KSAs):

* Knowledge of email and computer usage

* Skilled in written and verbal communication

* Customer service skills

* Skilled in basic math

* Ability to organize and prioritize

* Ability to use logic and problem solving

Selective Preference(s):

* Knowledge of Medicare and Medicaid laws, State and Federal rules and regulations

* Bilingual (Spanish) is a plus, but not required

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

 
 

Clipped from: https://jobs.azahcccs.gov/financial-eligibility-specialist-2/job/15590448?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

MRI Oklahoma City, OK

**SALARY WILL BE DOE**

This position will direct and provide leadership to the Oklahoma Medicaid (SoonerCare) Compliance team. The key performance initiatives include the following: project management, risk analysis, vendor management, internal auditing, creating and reviewing Oklahoma Medicaid reports, HIPAA disclosures, FWA activities, drafting and responding to internal and external Corrective Action Plans, and interacting with the Oklahoma Health Care Authority (OHCA).

Essential Duties:

• Oversee development and implementation of all approved Oklahoma Medicaid Policies and Procedures to ensure compliance with the Oklahoma Medicaid Contract;
• Oversee complex project management tasks which involve high risk compliance issues which may expose LIBERTY to litigation and/or sanctions, penalties, liquidated damages, and/or fines;
• Oversee internal workgroups to resolve and mitigate potential risks;
• Oversee tracking and monitoring of all Oklahoma Medicaid contractual commitments to ensure contractual obligations are met;
• Oversee drafting and responses to internal and external Corrective Action Plans which identify potential areas of non compliance and demonstrate resolution of any identified deficiency;
• Oversee the onboarding and monitoring of all approved Oklahoma Medicaid subcontractors/vendors by National Compliance;
• Oversee the responses to regulatory inquiries and regulatory audits which involve the Oklahoma Medicaid contract;
• Ensure tracking of new requirements specific to the Oklahoma Medicaid Contract and provide guidance to business owners on existing and new Oklahoma Medicaid requirements;
• Work with Corporate Compliance to investigate HIPAA, Privacy, and Security issues related to the Oklahoma Medicaid Contract; and 
• Attend regulatory meetings with OHCA, Medicaid Program Integrity, and the State of Oklahoma

Qualifications

Education and/or Experience:

• BS/BA from a 4-year college or university – preferably in business administration, health care administration, finance, accounting, or criminal justice.
• Minimum of 4 years’ experience as a Medicaid/Medicare Compliance Officer.
• 5 years of healthcare/dental investigative experience in one of the following areas: Law enforcement, a juris doctorate, fraud certification, medical coding certification, or a medical professional such as a doctor, dentist, or registered nurse.

Specific Skills/Knowledge:

• Knowledge of Medicaid contracts, legal requirements and laws, investigative and accounting procedures, data processing systems, auditing, claims processing, claims systems, medical/dental review, appeals, membership, and enrollment.
• Knowledge of Oklahoma Medicaid Rules and Regulations.
• Strong people skills and the ability to be resourceful, as well as to make concise, independent and defensible decisions in often high-pressure situations.
• Strong organizational skills which allow simultaneous completion of tasks and duties while maintaining the ability to coach and develop staff.
• Proven ability to effectively communicate orally and in writing detailed and complex information to others that possess varying degrees of comprehension.

 
 

 
 

Clipped from: https://www.ziprecruiter.com/c/MRI/Job/Director-of-Compliance-Medicaid-(OK)/-in-Oklahoma-City,OK?jid=fc3d66e38a3cbef8&lvk=6rwWyefoAbZ7MPmTMV1Bbw.–Lvz8DjV63&utm_campaign=google_jobs_apply&utm_medium=organic&utm_source=google_jobs_apply

 
 

POSITION TITLE:    Title XIX Medicaid Case Manager – CM 5                                   

REPORTS TO: Program Manager 

SUPERVISES: None

STATUS:  Non-Exempt 

SUMMARY:

Case Managers are responsible for the development, implementation, and monitoringof Long TermCare Services to Medicaid recipients, 18 and older. Services are responsive to the needs of the client that enable them to reside in their home setting of choice, while meeting quality assurance measures in accordance to Medicaid and Health Care Authority regulations and policies.Case Managers provide client-centered approachesto support the client’s independence andadministerthe department’s Comprehensive Assessment, Reporting & Evaluation (CARE) assessment that determines functional eligibility.

 
 

 
 

GENERAL RESPONSIBILITIES:

Include the following. Other duties periodicallyassigned by the ProgramManager, Community

Living Connections (CLC) Division Director, and/or Assistant Director.

 
 

Case Management:

*         Conduct in-person/remote comprehensive assessments at least annuallyto determine in-home functional eligibility for Long Term Care Services for clients.

*         Provide case management services to include; service plan development, care plan implementation, and appropriate service plan termination.

*         Authorize services according to that plan and monitor that plan is being appropriately applied and meeting the client’s needs.

*         Manage/liaison client-related requests for additional resources or supports.

*         Maintain working knowledge of the department regulations and procedures involvingall programs Rural Resources administers.

*         Provide client advocacy as well as consultation, program networking, familialsupport, and crisis intervention.

Administrative:

*         Remain current on state and federal policy, laws and regulations governing program and services.

*         Maintain systems and record keeping for the proper evaluation, control, and documentation of assigned operations.

*         Prepare reports and correspondence as required.

 
 

 
 

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of dynamics of aging and long term care services, case management principles and practices, quality assurance approaches, social service program monitoring and evaluation techniques, simple mathematical functions, data collection techniques, technical report writing, and computer applications in social services.

*         Strong boundaries to conduct constructive, supportive approach to effectively triage with the client/care providers/medical professionals/medical equipment contractors/community stakeholders.

*         Able to work together as a team to achieve successful outcomes for our shared clients in combination with the ability to work independently making decisions, at times, in immediate safety situations.

*         Knowledge of Medicaid terminology/acronyms, regulations, and policies.

*         Knowledge of DSHS database systems such as payment systems and service eligibility programs.

*         Professional experience working with vulnerable adults assessing risk and determining functional capabilities.

*         Strong skills in prioritization, organizational and time management skills.

 
 

 
 

REQUIRED EDUCATION AND EXPERIENCE:

A Bachelor’s degree in social services, human services, behavioral sciences, criminal law/justice or an allied field and two to three years related experience.

 
 

 
 

REQUIRED CERTIFICATION AND LICENSES:

• Valid driver’s license in state of residence.
• Auto insurance in the amount required by the State of Washington.
• Access to reliable transportation.
• Acceptable completion of a criminal history background check.
• Obtain tuberculosis (TB) vaccination within two weeks of employment.

 
 

 
 

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job.

• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone, and keyboard reach.
• Specific vision abilities required by this job include close vision requirements due to computer work.
• Light to moderate lifting is required.
• Ability to uphold the stress of traveling.
• Regular, predictable attendance is required.

The work environment characteristics described are what is encountered while performing the essential functions of this job.

• Moderate noise (i.e. business office with computers, phone, and printers, light traffic).
• Ability to work in a confined area.
• Ability to sit at a computer terminal for an extended period.

 
 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 
 

 
 

*   Denotes Essential Functions

 Clipped from: https://job-openings.monster.com/title-xix-medicaid-case-manager-pullman-wa-us-rural-resources-community-action/224635792?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Louisiana Department of
Public Safety & Corrections –
Corrections Services
DEPT OF CORRECTIONS HEADQUARTERS
Baton Rouge, LA

www.doc.louisiana.gov

THIS POSITION WILL BE FILLED AS A TEMPORARY JOB APPOINTMENT

DETAIL – The selected employee may be required to serve a trial detail prior to being permanently promoted.

TEMPORARY JOB APPOINTMENT – This position may be filled by temporary job appointment. If filled as a temporary job appointment, should a permanent position become available, the employee may be converted to a probational appointment.

This position is located at DOC-Headquarters, Health Services in Baton Rouge, LA.

As part of a Career Progression Group, vacancies may be filled from this recruitment as a Medicaid Analyst 1, 2, or 3 depending on the level of experience of the selected applicant(s). Please refer to the ‘Job Specifications’ tab located at the top of the LA Careers ‘Current Job Opportunities’ page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level.


In the supplemental questions section, applicants must authorize the HR Office of DPS&C-Corrections Services to contact prior employers to check references under the Prison Rape Elimination Act (PREA) to be considered for employment.


Applicants must have a Civil Service test score for 8100-Professional Level Exam in order to be considered for this vacancy unless exempted by Civil Service rule or policy. If you do not have a score prior to applying to this posting, it may result in your application not being considered.

Applicants without current test scores can apply to take the test here.

Any qualifying experience that is based on college credit/college hours should have an accompanying transcript for verification. The transcript should be attached to the application or faxed prior to the close of this announcement for your application to be considered. Fax to (225) 342-5968, or mail by close of this announcement.


>>>> An attached resume will not replace a completed application. <<<<


****REVIEW YOUR APPLICATION TO MAKE SURE IT IS CURRENT. Failure to provide your qualifying work experience may result in your application not being considered.****


Any degree, certificate, special license, or DD-214 must be verified by official documentation prior to hire.


This Agency is a Drug Free Workplace.


The Louisiana Department of Public Safety and Corrections – Corrections Services is an Equal Opportunity Employer and does not discriminate based on any non-merit factor including disability.


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.


There is no guarantee that everyone who applies to this posting will be interviewed. 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.


*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*


For information about this job posting contact:
Roderick Wells or Sara Barton
(225) 342-6664 or (225) 342-8627
Department of Corrections
P.O. Box 94304
Baton Rouge, LA 70804-9304
Fax: 225-342-5968

 
 

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate

degree.

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 will substitute 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.

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.

NOTE:

An applicant may be required to possess a valid Louisiana driver’s license at time of appointment.

Job Concepts

FUNCTION OF WORK:

To make initial and continuing determination, under close supervision, as to clients’ eligibility for all Medicaid programs.

LEVEL OF WORK:

Entry.

SUPERVISION RECEIVED:

Medicaid Analysts typically report to a Medicaid Analyst Supervisor. May receive supervision from higher level personnel.

SUPERVISION EXERCISED:

None.

LOCATION OF WORK:

Department of Health and Hospitals, Medical Vendor Administration.

JOB DISTINCTIONS:

Differs from Medicaid Analyst 2 by the presence of close supervision and the absence of independent action.

Examples of Work

EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.

Under close supervision, the entry level Medicaid Analyst learns to perform the following duties:

Conducts interviews with clients and makes other necessary collateral contacts for verification in determining eligibility for Medicaid Programs.

Examines application packets for timeliness, completeness, and appropriateness prior to authorization of reimbursement.

Makes decisions on complex eligibility factors and determines level of benefits for federal and state funded programs as a result of the rolldown procedure.

Interprets and applies complex federal, state, and agency policies for each program.

Conducts special investigations and compiles reports concerning fraud and location of absent parents.

Counsels and refers potentially eligible recipients or applicants to other agencies.

Contacts individuals, companies, businesses, local, state and federal agencies as needed to obtain or to verify information.

Records findings, recommendations, and services provided; completes case record forms and necessary correspondence in connection with assigned cases.

 
 

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Executive Account Director (Medicare/Medicaid)

• Job Reference: 235071088-2
• Date Posted: 22 February 2021
• Employer: Deloitte Touche Tohmatsu Limited
• Location: Mechanicsburg, Pennsylvania
• Salary: On Application
• Sector: HR / Recruitment
• Job Type: Permanent

 
 

We have been informed of instances where jobseekers are led to believe of fictitious job opportunities with Deloitte US (“Deloitte”). In one or more such cases, false promises of actual or potential selection, or initiation or completion of the recruitment formalities appear to have been or are being made. Some jobseekers appear to have been asked to pay money to specified bank accounts of individuals or entities as a condition of their selection for a ‘job’ with Deloitte. These individuals or entities are in no way connected with Deloitte and do not represent or otherwise act on behalf of Deloitte. We would like to clarify that:At Deloitte, ethics and integrity are fundamental and not negotiable.We are against corruption and neither offer bribes nor accept them, nor induce or permit any other party to make or receive bribes on our behalf.We have not authorized any party or person to collect any money from jobseekers in any form whatsoever for promises of getting jobs in Deloitte.We consider candidates only on merit and that we provide an equal opportunity to eligible applicants.No one other than designated Deloitte personnel (e.g., a Deloitte recruiter or Deloitte hiring partner) is permitted to extend any job offer from Deloitte.Anyone who at any time has made or makes any payment to any party against promises of job or selection for a job with Deloitte or any matter related to this (including those for ‘registration’, ‘verification’ or ‘security deposit’) or otherwise engages with any such person who has made or makes fraudulent promises or offers, does so (or has done so) entirely at their own risk. Deloitte takes no responsibility or liability for any such unauthorized or fraudulent actions or engagements.We encourage jobseekers to exercise caution.Are you an analytical, data-driven professional with strong leadership skills? Are you interested in a role that offers an opportunity to provide front line support to our clients? If so, Deloitte’s Government and Public Services (GPS) Advisory Analytics team is the place for you! Join our team of specialists as they unlock insights contained in the data universe and work through challenges related to the identification of improper payments, data quality, mission-oriented analysis, and cost management.Work you’ll do As a Senior Manager within our Analytics team, you will: • Organize and deliver services on a cross-section of complex projects• Provide overall leadership, coordination, and implementation of the PIMS solution• Communicate with Commonwealth executives and other MMIS module contractors, as needed.• Function as the primary point of contact with the MMIS 2020 Platform Executive Review Board, MMIS 2020 Platform Steering Committee and the MMIS 2020 Platform Project Team for activities related to contract administration, overall project management and scheduling, correspondence between the Department and the selected Offeror, dispute resolution, and status reporting to the Department.• Responsible for approving the invoices submitted to the Department• Oversee Disaster Recovery• Actively participate in the development of business and vendor relationships • Responsible for project(s) financials including development of financial plans • Manages day-to-day interactions with clients and internal Deloitte team• Displays both breadth and depth of knowledge regarding functional and technical issues• Displays leadership and business judgment in anticipating client/project needs and developing alternative solutions• Provide counseling/coaching, oversight, and support for delivery teams and staff• Actively participate in staff recruitment and retention activities providing input and guidance into the staffing processThe TeamTransparency, innovation, collaboration, sustainability: these are the hallmark issues shaping GPS government initiatives today. Deloitte’s GPS practice is passionate about making an impact with lasting change. Carrying out missions in the GPS practice requires fresh thinking and a creative approach. We collaborate with teams from across our organization in order to bring the full breadth of Deloitte, its commercial and public sector expertise, to best support our clients. Our aspiration is to be the premier integrated solutions provider in helping to transform the GPS marketplace.Advisory Analytics mitigates current and future risk for our GPS clients across several industries, spanning from finance and audit readiness to forensics and healthcare. With a creative and innovative approach, our Analytics team exposes our clients’ risks and provides recommendations to improve the quality of data. We collaborate closely with government agencies, accountants, IT professionals, and clients to produce analyses in support of risk consulting engagements. QualificationsRequired:• Bachelor’s Degree in Economics, Finance, Statistics, Mathematics, Computer Science, Management Information Systems, Engineering, Business Analytics disciplines, or related area • 10 years of experience working on and/or leading large, complex system implementation projects for similar clients • Knowledge of Medicare and Medicaid Services (MDS)• Knowledge of the Health and Human Services (“HHS”) industry• Ability to resolve project-related issues and risks requiring action by subcontractors• Ability to commit selected Offeror resources as needed to successfully perform work• Ability to identify and resolve project-related issues and risks requiring escalation within the selected Offeror organization• Ability to resolve project-related issues and risks requiring action by subcontractors• Experience mentoring and coaching others• Proven leadership skills demonstrating strong judgment, problem-solving, and decision-making abilities• Experience managing senior-level client relationshipsPreferred:• Previous Federal Consulting and/or professional services experience • Advanced Degree in related fieldHow you’ll growAt Deloitte, our professional development plan focuses on helping people at every level of their career to identify and use their strengths to do their best work every day. From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to help sharpen skills in addition to hands-on experience in the global, fast-changing business world. From on-the-job learning experiences to formal development programs at Deloitte University, our professionals have a variety of opportunities to continue to grow throughout their career. Explore Deloitte University, The Leadership Center.Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. Deloitte’s culture Our positive and supportive culture encourages our people to do their best work every day. We celebrate individuals by recognizing their uniqueness and offering them the flexibility to make daily choices that can help them to be healthy, centered, confident, and aware. We offer well-being programs and are continuously looking for new ways to maintain a culture where our people excel and lead healthy, happy lives. Learn more about Life at Deloitte.Corporate citizenship Deloitte is led by a purpose: to make an impact that matters. This purpose defines who we are and extends to relationships with our clients, our people and our communities. We believe that business has the power to inspire and transform. We focus on education, giving, skill-based volunteerism, and leadership to help drive positive social impact in our communities. Learn more about Deloitte’s impact on the world.Recruiter tips We want job seekers exploring opportunities at Deloitte to feel prepared and confident. To help you with your interview, we suggest that you do your research: know some background about the organization and the business area you’re applying to. Check out recruiting tips from Deloitte professionals.As used in this posting, “Deloitte Advisory” means Deloitte & Touche LLP, which provides audit and enterprise risk services; Deloitte Financial Advisory Services LLP, which provides forensic, dispute, and other consulting services; and its affiliate, Deloitte Transactions and Business Analytics LLP, which provides a wide range of advisory and analytics services. Deloitte Transactions and Business Analytics LLP is not a certified public accounting firm. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. These entities are separate subsidiaries of Deloitte LLP. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.Requisition code: E21ADVRLSMPHBS128546

 
 

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Business Analyst with Medicaid Experience

The Business Analyst primarily functions to review, analyze, and evaluate user requirements and system functionality. Tasks will include performing detailed requirements analysis, documenting processes, and validating system performance against requirements. The Business Analyst should have a natural analytical way of thinking and be able to explain difficult concepts to non-technical users. Medicaid program and system experience are highly desired.

 
 

JOB RESPONSIBILITIES:

• Evaluating business processes, anticipating requirements, uncovering areas for improvement, and developing and implementing solutions.
• Work closely with clients, technicians, and managerial staff.
• Perform user acceptance testing.
• Contribute expertise in provider services-related business functions, including advanced knowledge in the review and approval of provider eligibility
• Lead/support requirements and design sessions
• Analyze, document and clarify system business requirements
• Create Functional Design Documents for system enhancements
• Manage scope and implementation schedules for product releases
• Support federal system certification
• Execute system tests before User Acceptance Testing
• Maintain system documentation
• Interact daily with state clients and internal customers regarding system status and day-to-day processing
• Support user staff with analysis and resolution of issue reports
• Analyze complex data and measure outcomes
• Coordinate with technical staff to sufficiently understand technical requirements, specifications, and processes
• Interact with company and client managers and perform cost/schedule monitoring
• Other duties as assigned by management

EDUCATION AND EXPERIENCE REQUIREMENTS:

• A minimum of a bachelor’s degree or four years related work experience
• Two years of direct experience as a business analyst in design, development, testing, and implementation of software
• Knowledge of Medicaid and provider enrollment business processes
• Knowledge of system design and development process Strong understanding of system testing metrics, best practices, and methodologies
• Experience with EDI X12 transactions preferred (270 – Member Eligibility, 278 – Prior Authorization, and 837 – Claims Submission, 276/277 – Claims Adjudication)
• Experience with Provider screening, certification, and credentialing activities and interfaces preferred
• Experience working with State government clients in the Medicaid systems domain preferred
• Strong interpersonal skills
• Excellent organizational, interpersonal, verbal, and written communication skills
• Ability to perform comfortably in a fast-paced, deadline-oriented work environment
• Ability to successfully execute many complex tasks simultaneously
• Ability to work as a team member, as well as independently

 
 

Clipped from: https://www.myvalleyjobstoday.com/jobs/business-analyst-with-medicaid-experience-columbus-ohio/235001054-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

$ 80,000+

Job Description
Job Summary
Responsible for research & intelligence gathering, analysis, and project management in support of Molina’s business development efforts, with particular emphasis on merger and acquisition activity. Monitors activity in other markets that may develop into opportunities. Leads managed-care related business development activities for national, state, and local conferences, seminars, and meetings.
Knowledge/Skills/Abilities
• Identifies, tracks, qualifies and pursues new business opportunities in new targeted markets.
• Identifies customer needs and crafts initial “win” themes and strategies, and advises management concerning corporate sales and marketing strategies and tactics.
• Understands state agency and others’ expectations and builds Molina brand awareness with the state agencies and other constituencies.
• Develops relationships with relevant legislative bodies, constituents, and advocacy groups and associations in target markets.
• Works with Corporate Marketing to develop materials that establish and promote Molina’s expertise in government programs.
Job Qualifications
Required Education
Graduate Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10+ years
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.
Full time

Clipped from: https://careerlift.jobs/molina-healthcare-avp-business-development-medicaid-remote-97029936?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic