Category: MM Curator

Description/Job Summary

Sellers Dorsey is a leading healthcare consulting firm specializing in Medicaid financing, policy and operations. Our National Medicaid Financing Practice works with clients such as states, counties, health systems, safety net hospitals, academic medical centers, physicians, nursing facilities and medical schools navigate the opportunities to strengthen their Medicaid business through the conception, creation and implementation of programs designed to increase Medicaid reimbursement and leverage their unique capacities to deliver on the quality and value propositions growing in Medicaid. Our teams work together to ensure that technical, policy and political solutions are created to ensure successful results for our clients, particularly in the area of Medicaid financing.

The Associate Director will assist the Sellers Dorsey team by leveraging deep knowledge of policy and/or financial expertise in areas such as Medicaid financing and revenue maximization, provider reimbursement (physician, hospital, other), state and federal Medicaid reimbursement policy, healthcare taxes, intergovernmental transfers, and navigating the shift to value-based payment and/or provider operations. They are responsible for policy guidance, development of financial estimates and understanding state and federal reimbursement systems.

The Associate Director is a key member of the client servicing team, helping implement and manage new programs for clients and ensuring a high level of satisfaction. In addition to client servicing, the Associate Director assists the sales team by identifying new business opportunities, expanding existing engagements and participating in sales activities, including attending prospective client meetings.

Responsibilities/Duties

General Responsibilities and Expectations

• Associate Directors are expected to account for hours on a monthly basis. They will be assigned to client project teams and will also spend time on sales and marketing and administrative activities, as needed. Associate Directors are expected to review periodic activity reports and work with their supervisors to develop strategies to ensure targets are met.
  
• Sellers Dorsey Associate Directors are expected to travel as needed to meet the needs of client servicing, marketing, and business development. National travel up to 50% may be required. Associate Directors understand that work may require periodic availability on weekends and nights.
  
• Associate Directors are responsible for keeping current on the changing federal regulatory environment, learning state specific regulations to support assigned projects, and staying current on industry trends.
  

Consulting Services

• Depending upon specific areas of expertise, assume significant levels of responsibility on a diverse range of projects and project tasks; develop consulting expertise that can be replicated in future projects.
  
• Manage all technical aspects of Medicaid financing initiatives.
  
• Perform assigned and agreed upon project tasks maintaining client satisfaction; takes ownership of work and assists in the development of “client-ready” deliverables.
  
• Deliver subject matter expertise and consulting services for multiple clients/projects, clients and engagements; manage assigned primary research and/or solution development; assist with proposal development, project plan development, data analysis and modeling, presentation development, and delivery of client presentations.
  
• May serve as a key client contact to respond to questions, provide required communications and be responsible for a successful client engagement
  

Business Development

• Use personal industry knowledge, connections, business expertise, public policy awareness and political insight to identify leads that could result in profitable revenue growth for the Firm.
  
• Actively provide proposal development assistance including proposal drafting, editing, scope development, and related duties and participate in sales meetings, as necessary.
  
• Actively seek to identify new business opportunities for the Firm within assigned clients to help maximize long term benefits and relationship between the client and Sellers Dorsey.
  
• In coordination with the marketing team, produce and review content for selected internal and external marketing tools, such as Firm newsletters, conference presentations, website content, and marketing webinars, to highlight the Firm’s capabilities, subject matter expertise and successes.
  

Knowledge Management

• Leverage policy and/or healthcare solution expertise to help the Firm develop, document and communicate new solutions.
  

Required Qualifications

Education and Work Experience

• Bachelor’s degree and 10 or more combined years in Medicaid, provider reimbursement and/or in the healthcare consulting industries.
  
• Understanding of Medicaid financing and payments.
  
• Experience working with healthcare data such as claims sets, cost reports, etc.
  
• Experience in Medicaid agency, CMS or healthcare providers preferred.
  
• Experience with value-based payment arrangements preferred.
  

Skills

• Extensive practical knowledge and application of Medicaid reimbursement rules
  
• Ability to perform all the technical functions of a Medicaid financing initiative including but not limited to:
  

• Assess potential Medicaid supplemental payments and related transactions in states where Consultant, Senior Strategic Advisor may not have prior knowledge.
  
• Utilize cost reports, disproportionate share (DSH) reports and other large datasets to drive decision points within a project.
  
• Determine all the steps needed to execute a Medicaid financing initiative.
  
• Provide detailed data analysis, models and summaries of the financial impact from policy or methodology changes.
  
• Calculate upper payment limits for a variety of providers and provider classes under the Medicaid program.
  
• Estimate the potential federal funds generated by an initiative as well as the transaction costs.
  
• Assess project data needs and collect the data necessary to carry out the above activities.
  
• Respond to questions and inquiries by the Centers for Medicare and Medicaid Services (CMS) and keep track of recent CMS decisions and decision-making procedures.
  
• Assist clients in developing policies, procedures and structures required to implement the project.
  
• Understanding of the connection between reimbursement, quality and value at both the state and provider levels.
  
• Provide subject matter expertise related to Medicaid managed care, rate development, and metrics related to clinical or financial measurement.
  
• Serve as a mentor to junior staff, leveraging as appropriate to execute client deliverables.
  
• High proficiency in Microsoft Word, Excel, Access required.
  
• Simultaneously balance the needs and timeliness of many projects.
  
• Work closely with the project director and project managers to draft public notices, state plan amendments, 438.6(c) preprints, waiver amendments, memos, workplans, and external or internal progress reports, client-ready spreadsheets and calculations.
  
• Provide technical leadership and explanation to multiple levels of the organization to build internal capacity and foster knowledge management.
  
• Excellent oral and written communication skills including relaying complex technical terms in an easy to understand manner. This includes producing written or pictorial materials for external and internal use and to present calculations in a manner that the client or other staff can reasonably follow.
  
• Ability to interact professionally with clients and other outside audiences.
  
• Work with legal counsel when necessary in designing new payment initiatives.
  
• Attention to detail.
  
• Ability to work independently and in teams.
  
• Time management skills.
  
  
  

Core Behaviors And Competencies

• Build positive relationships within and outside the Firm.
  
• Treat clients, strategic partners and fellow employees with respect and professionalism in all interactions.
  
• Take ownership for one’s professional development by increasing knowledge, skills and abilities in areas that are critical to the Firm’s success.
  
• Collaborate and share knowledge with other Firm staff.
  
• Demonstrate formal and ad hoc team leadership in projects, issues or organizations that are critical to achieving the Firm’s strategic goals.
  
• Be self-motivated, and be an advocate for one’s abilities and talents, both internally and externally.
  
  
  

Key Performance Metrics/Expectations

• Individual performance goals.
  
• Successful completion of deliverables, tasks, projects
  
• Professional development
   
  

We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state, or local law.


If you need a reasonable accommodation for any part of the employment process, please contact us by email at reasonableaccommodations@sellersdorsey.com and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this e-mail address. For more information, view the EEO is the Law Poster and Pay Transparency Statement.


This position requires that you be fully vaccinated against Covid-19. Requests for reasonable accommodation on the basis of disability and/or sincerely held religious beliefs will be provided subject to undue hardship.


Sellers Dorsey maintains a Drug-Free workplace.

Clipped from: https://www.linkedin.com/jobs/view/associate-director-medicaid-finance-sme-remote-at-sellers-dorsey-3289027465/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Requisition No: 745541

Agency: Office of the Attorney General

Working Title: MEDICAID FRAUD ANALYST II – 41001290

Position Number: 41001290

Salary: $32,697 – $37,000

Posting Closing Date: 10/08/2022

Our Organization and Mission: The Office represents the State of Florida in state and federal civil and criminal courts, from trial courts to the Supreme Court of the United States.

Pay: $32,697 – $37,000 Annually

Position Summary: This position is in the Medicaid Fraud Unit. The incumbent in this position provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. The incumbent also performs work conducting detailed research and analysis of investigative information relating to alleged violations of applicable laws pertaining to health care fraud, in the administration of the Medicaid program, and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program. In addition, the incumbent may also perform as the lead analyst on specialized complex civil enforcement investigations and litigation matters, and analytical projects.

Qualifications: A bachelor’s degree from an accredited college or university and one year of professional experience in research, investigations, investigative analysis, or statistics.
Professional or nonprofessional experience as described above can substitute on a year-for-year basis for the required college education.

Preference will be given to candidates who have experience compiling and analyzing investigative information, or experience in the use of spreadsheets and relational database applications.

The Work You Will Do: The responsibilities of this position include, but are not limited to the following:

• 35% Create customized downloads from on-line Medicaid claims data warehouse as requested by investigators, attorneys, and multistate investigative and litigation teams.
  
• 25% Prepare reports/schedules/charts pertaining to all aspects of the analysis and research for use in criminal prosecution, civil actions, and administrative referrals.
  
• 20% Assists and supports Medicaid fraud investigators and attorneys in the compilation and analysis of investigative information and the development of damages models for use in Florida specific and multistate health care fraud investigations and litigation. Obtains and analyzes large amounts of data to interpret and summarize health care fraud activity, calculate damages sustained to the Florida Medicaid program, determine significance, completeness, and usefulness of data, recognize, and identify patterns and trends, and brief investigators and attorneys.
  
• 10% Extract information from investigative databases. Compile, analyze and disseminate intelligence information retrieved from various computer databases/systems. Perform various duties related to computers.
  
• 5% Assist in the prosecution of Medicaid fraud and/or patient abuse to include testimony in courts of law pertaining to the investigation.
  
• 5% Other duties as assigned.
  

Other Requirements: Experience in compiling and analyzing investigative information to include financial and/or statistical data. Experience in creating reports based on information analyzed for use in criminal, civil, and administrative proceedings. Must have strong computer knowledge in the use of spreadsheet and database applications.

**SKILLS VERIFICATION TEST** All applicants who meet the screening criteria/minimum job requirements will be required to take a timed Skills Verification Test. Applicants must receive a score of at least 70% to move to the interview phase.

The Benefits of Working for the State of Florida: Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• Annual and Sick Leave benefits.
  
• Nine paid holidays and one Personal Holiday each year.
  
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance option.
  
• Retirement plan options, including employer contributions (For more information, please click www.myfrs.com).
  
• Flexible Spending Accounts
  
• Tuition waivers.
  
• And more! For a more complete list of benefits, visit www.mybenefits.myflorida.com.
  

IMPORTANT NOTICE: To be considered for the position, all applicants must:

Submit a complete and accurate application profile necessary for qualifying such as dates of service, reason for leaving, etc. In addition, all applicants must ensure all employment and/or detailed information about work experience is listed on the application (including military service, self-employment, job-related volunteer work, internships, etc.) and that gaps in employment are explained. NOTE: Any required experience and/or preferences listed in the advertisement must be verified at the time of application.

• Ensure that applicant responses to qualifying questions are verifiable by skills and/or experience stated on the employment application and/or resume. Applicants who do not respond to the qualifying questions will not be considered for this position.
  
• The elements of the selection process may include a skill assessment exercise.
  
• Current and future vacancies may be filled from this advertisement for a period of up to six months. Following the six-month period, a new application must be submitted to an open advertisement to be considered for that vacancy.
  
• OAG employees are paid biweekly. All state employees are required to participate in the direct deposit program pursuant to s. 110.113, FS.
  

CRIMINAL BACKGROUND CHECKS/ DRUG FREE WORKPLACE: All OAG positions are “sensitive or special trust” and require favorable results on a background investigation including fingerprinting, pursuant to s. 110.1127(2)(a), F.S. The State of Florida supports a Drug-Free Workplace, all employees are subject to reasonable suspicion or other drug testing in accordance with section 112.0455, F.S., Drug-Free Workplace Act. We hire only U.S. citizens and those lawfully authorized to work in the U.S.

E-VERIFY STATEMENT: The Office of the Attorney General participates in the U.S. government’s employment eligibility verification program (e-verify). E-verify is a program that electronically confirms an employee’s eligibility to work in the United States after completion of the employment eligibility verification form (i-9).

REMINDERS: Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Service System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from SSS. For more information, please visit the SSS website at: https: //www.sss.gov. If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended, or deemed ineligible depending upon the date of your retirement.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.

Clipped from: https://www.glassdoor.com/job-listing/medicaid-fraud-analyst-ii-state-of-florida-JV_IC1154160_KO0,25_KE26,42.htm?jl=1008168954122&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

With over 100 offices and nearly 6,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level.  

CBIZ has been honored to be the recipient of several national recognitions:

• 2022 Top Workplaces USA
  
• 2022 Great Place to Work Certification
  
• Top 101 2021 Best and Brightest Companies to Work For in the Nation
  
• 2021 America’s Best Mid-Size Employers
  
• 2021 Best and Brightest Companies in Wellness
  

CBIZ Benefits & Insurance Services is a division of CBIZ, Inc., providing benefits consulting, HRIS technology, payroll, human capital management, property and casualty, talent and compensation solutions, and retirement & investment solutions to organizations of all sizes. CBIZ is ranked as a Top 20 Largest Broker of U.S. Business (Business Insurance Magazine) and a Top 100 Retirement Plan Adviser (PLANADVISER). 

Essential Functions and Primary Duties:

• Assisting patients in applying for financial assistance through Medicaid on behalf of our client facility.
  
• Interviewing patients or authorized representatives via phone or in person to gather information to determine eligibility for medical benefits.
  
• Obtaining, verifying, and calculating income and resources to determine client financial eligibility.
  
• Documenting case records using automated systems to form a record for each client.
  
• Following up with applicants to obtain accurate and complete information within strict timeframes.
  
• Completing/following up on all forms related to Medicaid eligibility.
  
• Performing any additional tasks related to the position assigned by the Manager.
  

 Preferred Qualifications:

• Bachelor’s degree. 
  
• Knowledge of Medicaid and Charity Care.
  
• Experience working in a hospital environment.
  
• Ability to speak and read Spanish.
  

Minimum Qualifications:

• High school diploma/GED.
  
• Must be ambitious and self-directed in a fast-paced environment and can perform in a high volume, multitasking setting.
  
• Must be trustworthy, professional, detail and goal oriented.
  
• Must have exceptional customer service and excellent verbal/written communication skills.
  
• Must be able to learn and work with Medicaid eligibility regulations.
  

REASONABLE ACCOMMODATION

If you are a qualified individual with a disability you may request reasonable accommodation if you are unable or limited in your ability to use or access this site as a result of your disability. You can request a reasonable accommodation by calling

844-558-1414

(toll free) or send an email to

accom@cbiz.com

.

EQUAL OPPORTUNITY EMPLOYER

CBIZ is an affirmative action-equal opportunity employer and reviews applications for employment without regard to the applicant’s race, color, religion, national origin, ancestry, age, gender, gender identity, marital status, military status, veteran status, sexual orientation, disability, or medical condition or any other reason prohibited by law. If you would like more information about your EEO rights as an applicant under the law, please visit these following pages EEO is the Law and EEO is the Law Supplement.

PAY TRANSPARENCY PROTECTION NOTIFICATION

Clipped from: https://careers.cbiz.com/en-US/job/medicaid-eligibility-specialist-ka-consulting/J3N5LH69LNY8LH0D125?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Louisiana is seeking an Associate Director, Care Management(Behavioral Health) who will use clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members. He/she will lead teams of nurses and behavioral health professionals responsible for care management. The Associate Director, Care Management requires a solid understanding of how organization capabilities interrelate across department(s). They will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.

Responsibilities

The Associate Director, Care Management (Behavioral Health) leads and guides others in providing integrated services to and for our customers. Provides ongoing associate coaching and feedback to enhance associate contribution, competency, and performance.

• Oversees day to day operations and associates for Louisiana Medicaid Care Management.
  
• Achieve performance metrics for a fast paced comprehensive case management environment.
  
• Assure compliance with mandated and corporate policies regarding other departmental areas such as medical management, utilization management and case management.
  
• Develop team members and creates department process flows.
  
• Will directly lead multiple managers and highly specialized professional associates.
  
• Oversees the assessment and evaluation of members’ needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well-being of members.
  
• Maintain compliance with Louisiana Department of Health (LDH), Department of Health and Human Services (DHHS), and the Centers for Medicare and Medicaid Services (CMS) guidelines and contractual requirements.
  
• Decisions are typically related to identifying and resolving complex technical and operational problems within department(s).
  

Required Qualifications

• Must reside in the state of Louisiana.
  
• Unrestricted Registered Nurse (RN) license in the state of Louisiana OR Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Physicians (Psychiatrists), Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
  
• Minimum five (5) years of previous clinical experience.
  
• Minimum of five (5) years of management/supervisory experience in the healthcare field.
  
• Proficiency in analyzing and interpreting data trends.
  
• Progressive business consulting and/or operational leadership experience.
  
• Comprehensive knowledge of Microsoft Office applications including, PowerPoint Word, Excel, and Outlook.
  
• Demonstrated knowledge of keyboard, Word, Excel, PowerPoint, email, and other Office software applications.
  
• This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least100,000/300,000/100,000limits.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Bachelor’s or Master’s Degree in nursing, public health, health administration, health policy or business.
  
• Knowledge of Humana’s internal policies, procedures and systems.
  
• CCM (Certified Care Manager).
  
• Experience with health promotion, coaching and wellness.
  
• Knowledge of community health and social service agencies and additional community resources.
  

Additional Information

• Workstyle: Hybrid Home – Works 1 – 2days/week in Humana’s Baton Rouge or Metairie, LA office location and 3 – 4 days remotely.
  
• Travel: Up to 25% of the time within the state of Louisiana.
  
• Direct Reports: Up to 8 Managers/Associates.
  
• Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#LouisianaMedicaid

Scheduled Weekly Hours

40

Clipped from: https://www.ziprecruiter.com/c/004-Humana-Insurance-Company/Job/Associate-Director,-Care-Management(Behavioral-Health)-Louisiana-Medicaid/-in-Thibodaux,LA?jid=43bdfb1e3a1f842a&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic