Category: MM Curator

 
 

Job Description

Job Summary
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.

 
 

Clipped from: https://motherworks.com/job/994457/director-request-for-proposal-medicaid-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Resp & Qualifications

This position is responsible for the governance of all DC Medicaid vendors and suppliers in partnership with the business owners for the contracts.  The corporate focus on centralized procurement, contracts and vendor governance requires focused leadership of the procurement activities for DC Medicaid.  DC Medicaid requires significant supporting procurement documentation; therefore this position will support business owners in DC Medicaid with creating, maintaining and storing procurement documentation which will withstand audit scrutiny.  This position will strive to influence budget reductions. A significant focus will be on vendor spend management through effective cost tracking, reporting, and performance management.  The integration of Ariba, SharePoint and shared drive information will be critical to successful and consistent procurement practices.  Corporate attention to Trading Partner controls and supplier risk assessment has resulted in additional analysis of vendor access to sensitive information that if not handled properly can result in negative exposure and adverse audit findings.

PRINCIPAL ACCOUNTABILITIES:

Under the direction of the Director of Strategic Planning and Development accountabilities include, but are not limited to, the following:

Contracts & Procurement Management

• Provide coordination of the contract management process in support of DC Medicaid functions
• Serve as the key liaison and interface with DC Medicaid Vendors and Corporate Vendor Oversight and Procurement
• Develop and maintain an enhanced database of all contracts and vendors
• Ensure that business owners within DC Medicaid take timely action to renew and competitively bid contracts prior to contract expiration.
• Create, maintain and store supporting documentation related to the procurement process including, but not limited to:

 
 

• Executive Summaries (Contracts and Projects)
• Risk Control Matrices
• Sole & Single Source Justifications
• Requests for Information
• Requests for Proposals
• Purchase Requests
• Sourcing Requests

• Work collaboratively with Strategic Sourcing & Procurement (SS&P) and business owners to manage the sourcing function by identifying, interviewing and prequalifying vendors.
• Work in partnership with DC Medicaid management and SS&P to develop customized procurement strategies to strengthen the vendor selection and contracting process
• Support the DC Medicaid management team in developing Statements of Work that clearly define business requirements to be reflected in Requests for Proposals
• Create and refine a process and document workflow for procurement activities
• Produce routine and ad-hoc reports for senior management. 
• Enforce CareFirst Finance and Procurement Policies by ensuring that DC Medicaid complies with all corporate policies related to Purchasing and Expense Authorization.

Vendor & Contract Spend Analysis

• Report upon the actual expenses incurred with contract vendors in DC Medicaid especially costs incurred against approved Executive Summaries.
• Perform routine evaluation of contract cost and expenditure approval status in compliance with company policies (in particular policy FIN.09)
• Conduct spending analysis of vendor spend against budget, expenditure approval and contract limits.
   

Vendor Governance

• Act as subject matter expert over the vendors and their contracts
• Work with business owners to develop strong and measurable performance indicators for key vendors and embed within contracts
• Develop tools and methods to measure vendor performance against performance standards. 
• Ensure all regulatory reports are being received timely and are organized and made available to all business owners.
• Act as Liaison between the vendor and the business owner.
• Ensure that quarterly vendor oversight meetings occur and are documented with minutes.
• Act as Secretary of the DC Medicaid Delegation Oversight Committee; sit on all corporate vendor committees; and regularly reports out to various committees as needed.
• Work with business owners to ensure that vendors have achieved performance standards and notify vendors that have not complied while managing a corrective action plan to address performance issues.
• Routinely rate and measure vendor quality and satisfaction of end users.

Other

Performs other duties as assigned including various projects in support of other departments in DC Medicaid.

QUALIFICATION REQUIREMENTS:

Required Education and Experience

• Bachelor’s degree in Business Administration, Finance or related field or equivalent work experience.
• 3 to 5 years of experience in Purchasing, Corporate Services, Contract Administration, or Finance
• Experience reading contracts including vendor contracts and SOWs.
• Experience with Medicaid preferred.
• Experience in interpreting business requirements and writing statements of work.
• Experience with Procurement practices and handling various types of contracts, SOWs, amendments and Purchase Orders.

 
 

• Excellent written and verbal communication skills (ability to write high quality drafts with minimal turnaround time, and to speak extemporaneously). Ability to interact with multiple levels of management.

Skills/Abilities

• Excellent organizational and interpersonal skills to work effectively with internal and external customers.
• Excellent ability to organize large projects and manage multiple priorities.  Must be self motivated.
• Ability to independently apply principles, theories, concepts and practices to difficult problems and makes recommendations and decisions concerning courses of action.
• Demonstrated innovation and creativity in problem solving.
• Individual must be detail oriented with a strong desire to ensure accuracy of reports and information.
• Excellent analytical skills.
• Excellent PC skills particularly in Microsoft Word, Excel, Power Point and Adobe Acrobat.
• Ability to travel to various CareFirst locations and vendor locations will be required from time to time

Preferred

• Experience in Contract Management
• Experience in vendor governance and managing vendor relationships
• Experience with reviewing and interpreting legal documents. 
• Master’s degree or advanced degree in Business Administration, Finance or related field
• Legal experience is a plus especially in the areas of contract law and business law.
• Oracle financial system experience
• Ariba procurement system experience
• Previous experience in coordinating and ensuring timely response to internal and external audits.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 11/19/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

 
 

Clipped from: https://carefirstcareers.ttcportals.com/jobs/5742314-vendor-relations-specialist-dc-medicaid?tm_job=14066-1A&tm_event=view&tm_company=2380&bid=538

 
 

 
 

 
 

Dallas, TX

• Associated topics: auto, casualty, claim, claim adjuster, claim investigator, claimant, insurance adjuster, investigation, liability, title examiner
• Now is the time to join our team ofmotivatedand nurturing individuals working to assist patients with their Medicaid Eligibility screening and enrollment.
• Benefits include 401k, paid time off, medical, dental, vision, flex spending, life, disability, tuition reimbursement, student loan repayment, employee discount program, and employee stock purchase program.
• Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.
• ABOUT USParallon is anindustry leaderin revenue cycle services.
• Obtain legal relevant medical evidence, physician statements and all other documentation required for eligibility determination, and complete and file itiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
• Do you have exceptional customer service and the ability to plan organize and exercise sound judgment?
• WHAT YOU WILL DO:Responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments.

Posted 9 hours ago

Clipped from: https://jobsearcher.com/j/medicaid-eligibility-advocate-at-hca-hospital-corporation-of-america-in-dallas-tx-oVMgp95?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

$ 40,000+

Supplemental Information

Job Number: MVA/CSH/2094
 
 This position is located within the Louisiana Department of Health l Medical Vendor Administration l Eligibility-Region 6  l Rapides Parish  

Cost Center: 0305-8361
Position Number(s): 50593301, 50593014
 
 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 that may last up to 48 months)

Applicants must have Civil Service test scores 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.

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:

Casey Hickman

Casey.Hickman@la.gov

LDH/Human Resources

P.O. Box 4818 Baton Rouge, La 70821

225-342-6477    
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.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.

 
 

Clipped from: https://careerlift.jobs/government-jobs-medicaid-analyst-1-94925086?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a regional office or Central Enrollment Office. Examples of Work: Examples of work performed in this classification include, but are not limited to, the following: Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region.Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations. Determines an applicant’s eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants’ applications. Maintains effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory. Verifies accuracy of information listed on applicants’ applications including income, bank accounts, and any other assets. Makes determination of an applicant’s eligibility based upon established criteria. Visits contact centers and medical facilities; assists other regional offices on an as-needed basis.Performs related or similar duties as required or assigned. Minimum Qualifications: These minimum qualifications have been agreed upon by Subject Matter Experts (SMEs) in this job class and are based upon a job analysis and the essential functions. However, if a candidate believes he/she is qualified for the job although he/she does not have the minimum qualifications set forth below, he/she may request special consideration through substitution of related education and experience, demonstrating the ability to perform the essential functions of the position. Any request to substitute related education or experience for minimum qualifications must be addressed to the Mississippi State Personnel Board in writing, identifying the related education and experience which demonstrates the candidate’s ability to perform all essential functions of the position.EXPERIENCE/EDUCATIONAL REQUIREMENTS: Education :A Bachelor’s Degree from an accredited four-year college or university.OR Education :An Associate’s Degree or completion of sixty (60) semester hours from an accredited college or university;AND Experience :Two (2) years of experience related to the described duties. Substitution Statement :Above an Associate’s Degree or completion of sixty semester hours from an accredited college or university, related education and related experience may be substituted on an equal basis. Essential Functions: Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:1. Maintains caseload for Medicaid eligibility.2. Maintains good public relations and customer service.3. Collects eligibility data information.4. Visits Medicaid contact centers and/or long-term care facilities.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-specialist-i-jackson-at-mississippi-state-personnel-board-2410484039/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

RICEFW Technologies Inc Jackson, MS

Job Description:

Participates in Joint Application Design (JAD) sessions, Detailed Design reviews, Agile sessions, project status

meetings and any other Medicaid project meetings, as necessary.

Participates in user acceptance testing by performing tests, analyzing, and documenting defects and issues.

Tracking identified issues and action items. Resolving issues and action items by following up with policy and vendors.

Required Skills/Experience

Provide the minimum required skills and/or experience the contractor must possess to qualify for this position. These requirements will be transferred to the Score Sheet and candidates without these requirements reflected on their resume will NOT be presented to the manager for consideration.

Years

Required Skills/Experience

2+yrs.

Experience with Federally sponsored benefit programs such as Medicaid, SANP, TANF

2+yrs.

Understanding of basic database principles

2+yrs.

Familiarity with and have participated in Joint Application Design (JAD) and/or Agile sessions

2+yrs.

Experienced in reviewing technical deliverable documents

2+yrs.

Experience with, understanding and maintenance of Requirements Traceability Matrix (RTM)

2+yrs.

Ability to write, execute and analyze results of test cases for multiple software applications

2+yrs.

Must be knowledgeable in the software System Development Life Cycle (SDLC) including the principles and practices of information systems analysis, design, development, implementation, maintenance, and security related functions.

N/A

Ability to document process flows and complex business requirements

N/A

Must have strong analytical and problem-solving skills

N/A

Must have experience in software testing including the following: Test plans, recording defects, assessing the severity of defects and documenting resolution of defects

N/A

Experience as a Business Analyst with Medicaid Eligibility Determination Systems

 
 

Clipped from: https://www.ziprecruiter.com/c/RICEFW-Technologies-Inc/Job/Business-Analyst-Medicaid/-in-Jackson,MS?jid=1fca4729e4146dc0&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Medical Mutual Cleveland, OH

Responsibilities

Directs Clinical Quality Management Programs for assigned functional areas Healthcare Effectiveness Data and Information Set (HEDIS), Disease Management and Wellness Promotion, Provider Quality, for Medicaid.  Oversees the analysis of the quality of member care and the development and implementation of programs that support continues quality improvement.  Establishes strategic plans, policies and procedures and collaborates with departments Companywide to ensure quality programs meet Company and regulatory requirements.

• Manages the strategies of the health plan’s clinical quality improvement department, including the activities for HEDIS, Medicaid and Provider Quality.
• Formulates and executes strategies that improve clinical outcomes and promote wellness for all lines of business, including managing the health plan’s disease management program, as well as vendor oversight.
• Works with cross disciplinary team to coordinate and perform medical informatics analysis for all lines of business.  Oversees the collection, analysis, reporting and trending of data relative to health- related baselines, outcomes and return on investment of intervention activities.
• Manages budgets and staffing for assigned area. Ensures there is knowledge of learning and training from all improvement projects, processes and initiatives to provide shared reporting with ODM and contracted Providers.
• Manages and coordinates the health plan’s clinical quality improvement (CQI) activities among functional areas, monitors the progress of CQI activities against the annual CQI work plan and ensures potential quality of care issues are investigated and resolved.
• Communicates and monitors quality initiatives, as well as promoting culture changes that support an environment of quality.
• Performs other duties as assigned.

Qualifications

Education and Experience:

• Bachelor’s degree in Nursing, Healthcare Administration or related healthcare field required. Master’s degree preferred.
• 8 years progressive clinical and managed care experience in quality management and quality improvement, 5 years of which are in management and/or leadership capacity driving large scale projects/programs companywide.
• Significant experience in government programs (Medicare/Medicaid).

Professional Certification(s):

• Registered Nurse actively licensed in the State of Ohio, preferred
• Certification in one of the following:

 
 

• Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHO)
• Certified QI Associate by American Society for Quality, and /or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment or within six months of date of hire.

Technical Skills and Knowledge:

• Comprehensive knowledge of managed care tools, components, delivery systems and models; 
• Comprehesive knowledge of evidenced-based clinical care management, regulatory/accreditation standards and operational management procedures, clinical quality programs, government programs.
• Advanced oral, written, and interpersonnal communication skills with the ability to present to various audiences includes executive management.
• Knowledge of and the ability to develop and manage Medicaid program improvement projects, and processes to identify and address health disparities.
• Knowledge of quality improvement applications, tools and methods.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we’ve received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We’re the largest health insurer in Ohio and for over 85 years, we’ve been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

 
 

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

 
 

Clipped from: https://www.ziprecruiter.com/c/Medical-Mutual/Job/Director,-Clinical-Quality-Improvement-Medicaid/-in-Cleveland,OH?jid=406fdb245a0ce7fe&utm_campaign=google_jobs_apply&utm_medium=organic&utm_source=google_jobs_apply

 
 

 
 

Employment Type:

Full-time

Exempt or Non-Exempt:
Exempt

Job Summary:
 

Focused on HMSA’s Government Programs plans (e.g. Medicare and Medicaid-related), extracts data from multiple internal and external sources, provides statistical, financial, and business analysis to help HMSA manage the Medicare and Medicaid line of business financial performance and cost of health care, such as evaluating quality improvement initiatives, the effectiveness of various health programs, population health improvements, and clinical outcomes that initiate action or change.

Functions independently and serve as a senior level subject matter expert on the performance management functions for HMSA’s Government Program plans. Leads projects and represents the department on organizational projects.

Minimum Qualifications:

• Bachelor’s degree and four (4) years of related experience, or an equivalent combination of education and related work experience.
• Strong working knowledge of the techniques used to present statistical data.
• Effective analytical skills to evaluate data reliability, determine appropriate statistical models, correlate factors and organize data.
• Strong written and verbal communication skills.
• Organization and time management skills to work on multiple projects simultaneously and meet project deadlines.
• Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.

Duties and Responsibilities:

Research and Analysis:

• Conduct research, uses algorithms and specific skills in quality improvement, medical statistics and financing and applies sound knowledge of statistical theory and its application to research methodology.
• Reconciles internal information related to risk scores and anticipated revenue, membership, and classification of HMSA’s membership with CMS and QUEST information, either directly or through oversight of other departments, to assure that HMSA is receiving proper credit and payment for all Government-related plans.
• Primarily responsible for data analysis from various sources to provide statistical data for financial modeling, quality improvement research and reporting for physicians and providing actionable data and reports to improve cost and quality of care. Ensures feasibility and evaluates reliability of data source information, conducts analysis of statistical data sets, interprets statistics and identifies significant relationships, and organizes results into a compatible and useful format to prepare conclusions and forecasts based on data summaries.
• Researches and identifies opportunities in performance of line of business such as RAPS/EDPS data submission accuracy, reducing error rates in LIS, MSP, or other indicators that impact premiums and develops action plans for recommendation.
• Analyzes claims data information and utilizes predictive algorithms to develop recommendations regarding interventions for health services programs.
• Develops reporting tools and maintains various database programs, including financial and clinical data, to analyze, track, review and support a variety of medical management activities.

Applications and Data Analysis:

• Responsible for design, analysis, development, integration, maintenance and support of specific internal applications related to data analysis.
• Completion of existing risk adjustment processes, workflows and programs.
• Takes primary lead on testing efforts of new or modified applications for department.
• Analyzes existing applications and/or designs new computing services or systems to complete data analyses and reporting required to meet changing goals.
• Evaluate system options, make recommendations, provides input and technical guidance. Develops necessary project plans for implementation to lead and coordinate problem tracking, resolution, and verification testing, as needed.

Project Management and Administration:

• Provides leadership to critical technology projects to assure data analysis and reporting capabilities are incorporated and available.
• Utilize project management techniques to document and coordinate activities to ensure deliverables are met.
• Perform cost/benefit analysis that supports business operations and project management. Assist to define solutions that support business flows through use of workflow design/redesign.
• Monitor, evaluate, interpret and disseminate program requirements related to risk adjustment activities. Ensure activities are conducted in accordance with applicable standards, line of business controls and requirements. Develop methods to improve daily operations and practice standards.
• Collaborates and works with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.

Reports and Presentations:

• Analyze/create derived results, translates data, and creates analytical presentations using tables, graphs, charts, written report or other methods.
• Produces written project and study reports in a structured and informative manner.
• Ensure reports and presentations are accurate, concise, clearly stated and appropriate for internal and external audiences and all levels of staff.
• Collaborates and works with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.
• Design reports to deliver data and information that will address and improve business needs.

 
 

Other Duties/Functions:

• Perform all other miscellaneous responsibilities and duties as assigned or directed.

Clipped from: https://www.glassdoor.com/job-listing/senior-business-analyst-medicare-medicaid-financial-performance-hmsa-JV_IC1140656_KO0,63_KE64,68.htm?jl=3647558694&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job details

The incumbent will identify business needs, solutions, write processes and procedures, and measure the effectiveness of solutions post-implementation for a wide variety of policy and program changes. The incumbent will be a strong team contributor, have the ability to lead and manage small projects and project teams. We are searching for an individual with exceptional business analysis skills including process flow development, requirements delivery, critical thinking, interpersonal skills and systems-thinking competencies.

Key Responsibilities

• Research and analyze business issues and operational changes
• Facilitate workgroups and business resources to define business needs, coordinate the gathering and reconciliation of detailed business requirements for system development
• Document business process work flows across the division, in coordination with project stakeholders, data and technology support teams
• Analyze issues, identify solutions and develop documentation to meet needs of business teams and programs
• Support project management efforts as assigned
• Create documentation to support business operations
• Maintain an electronic repository for written documentation including current and future business process flows, business requirements, user guides, and others as assigned
• Utilize and/or develop standardized tools that can be used to assess needs, document process flows, and contribute to training and communications to support project goals and business changes

Qualifications

• Good knowledge of project management
• Good knowledge of organizational/business analysis and evaluation
• Good knowledge of process improvement methodology
• Experience developing business process flows, business requirements and process documentation. Gained by at least one year of work experience where business process analysis was a primary responsibility and utilized analytical and facilitation skills and software tools to develop business process flows, requirements and process documentation.
• Certification of Competency in Business Analysis (CCBA/CBAP) status or certification. Gained by meeting certification requirements from the International Institute of Business Analysis (IIBA), Project Management Institute (PMI), Six Sigma certification or other certifying body.
• Experience using Smartsheets, SharePoint, Visio and PowerPoint. Gained by at least one year of work experience using the software.
• Experience with process engineering methodologies and/or operational processes. Gained by a Bachelor’s or Master’s degree in Engineering or Business Administration.
• Experience in change management. Gained by at least one year of work experience where leading change utilizing change management principles was the primary responsibility.

 

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We are seeking a Medicaid Business Analyst to join our team. We are in need of a strong business analyst with experience in a large Medicaid enterprise environment. This role will focus on the implementation of a large data warehouse environment initially using Medicaid data. This Business Analyst will work closely with both the Database Administration team and our development teams. Primary Responsibilities Work closely with customers to gather business requirements and translate requirements clearly into accurate specifications for the configuration of large data warehouse systems Use Application Lifecycle Management (ALM) tools such as IBM Rational to trace development and deliverables through the system development lifecycle Research MMIS managed care and fee for service policy to ensure system specifications are accurate to policy. Review deliverables and enforce the approval process of deliverables to ensure that quality assurance processes are strictly followed Proven ability to work with customers, DBAs, ETL programmers, Business intelligence architects, and PMO staff in a collaborative manner. Demonstrated knowledge of the use of Application Lifecycle Management tools (such as Rational, HP, DevSuite). Excellent communication and presentation skills with the ability to communicate complex technical concepts to business users in a clear and concise manner. Thorough understanding ICD-9, ICD-10, CPT-4, NDC and other medical coding standards Required Qualifications: Business Intelligence experience with at least one of the following tools: Cognos, Business Objects, MS Analysis Services, Hyperion, Oracle, Tableau 5+ years of experience working with Medicaid or health plan programs and data. Extensive knowledge of Federal and State healthcare programs (i.e., Medicaid, CHIP) and related eligibility/enrollment principles, and claims data Experience contributing to and managing the planning and execution activities for the following SDLC phases: Systems analysis and requirements definition Systems design System Testing User Acceptance Testing Maintenance and operation support Strong knowledge of SQL Experience with data analysis techniques, data modeling and data management tools (e.g., MS Excel, SQL language, relational databases) Preferred Qualifications: Understanding of ETL tools including Informatica and business intelligence tools including Cognos Experience with the IBM Rational Suite including Rational Team Center Understanding of relational & dimensional modeling Understanding of HIPAA privacy & security rules Knowledge of Medicaid payment policy and MMIS data Knowledge of Agile and waterfall development techniques Optum is a diversified health services and innovation company where data, technology, people and action combine to make great things happen every day. Join us. Learn more about how you can start doing your life’s best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: GovtConsulting Job Title: Medicaid Data Warehouse Business Analyst – Richmond, VA Shift: Day Job Travel: No Business: Optum State Govt Solutions Family: Information Technology Telecommuter Position: No Job Level: Individual Contributor Overtime Status: Exempt Posted Date: 9/7/2018 City: Richmond State: VA Country: United States Department: Optum State Govt Data Warehsng

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