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Management Consultant – IV&V Medicaid Job at Public Knowledge in Colorado


Management Consultant

Applicants must be willing to travel and should be within an hour of a major airport.

Company Summary

Public Knowledge is a national management consulting firm that helps government agencies solve tough problems and thrive in complex environments. We do this by providing planning, procurement, and implementation services. Most of our work is in Health and Human Services. You can learn more about us at GLI® Group has acquired Public Knowledge, which provides Public Knowledge with the financial backing and infrastructure of a larger company.

Position Summary

This management consultant would spearhead research efforts to gather information for large projects and programs and propose creative solutions. This person would collaborate with project managers and team members to support project administration, time management, and budgeting.

Duties & Responsibilities include, but not limited to:


  • Gather information for a project by conducting interviews, surveys, facilitating groups, analyzing client documentation, conducting research of best practice and academic literature, and the application of other information gathering tools.

Project Support

  • Learn and apply the tools and techniques we have for projects.
  • Work with project managers to support the administration of projects (ensure staff adhere to standards, organizing the time of other team members, supporting project meetings, and assisting with project financial management).
  • Help your team meet project objectives, timelines, and deliverables within budget.

Analysis, Communication, and Consultation

  • Using your experience and research results, analyze and organize information identifying root causes of issues, opportunities for improvement, and generate ideas to improve the client situation.
  • Based on your analysis, research, and experience participate with your team in the development of recommendations for actions that will improve the client situation.
  • Communicate the results of our work (information, analysis, and recommendations) through the participation in the development and delivery of written reports, formal presentations, and oral discussions with your team, and as requested clients and stakeholders.

Firm Knowledge Sharing and Growth

  • Freely share your knowledge, skills, and abilities with your peers in the firm.
  • Perform firm administrative activities (maintain your resume, record your time accurately).
  • Grow your skills and experience by participating in projects and actively pursuing continuing professional education.
  • Develop an effective working relationship with clients and colleagues.

Required Education and Other Credentials:

  • Bachelor’s Degree required
  • Valid Driver’s License
  • PMP certification is strongly preferred

Required Experience and Skills:

  • At least three (3) years of project management experience, preferably in major IT systems-related work.
  • At least three (3) years of experience conducting IV&V work, preferably in health or major IT systems-related work.
  • Experience in systems development best practices and knowledge of the typical artifacts created as part of a system development project is required. Knowledge of Medicaid and or Integrated Eligibility is a requirement and familiarity with MITA. Knowledge of multi-project integration programs and multi-system data consolidation efforts is preferred.
  • Knowledge of the components of Software Development Life Cycle and best practices including all waterfall and agile frameworks as well as SaaS, COTS, and Custom design solutions
  • Deep knowledge of Medicaid and Health IT that spans the development and testing of systems through the operation of the programs the technology supports
  • Proven ability to report observations, conclusions, and making recommendations for improvement about project problems and issues; ability to focus and to be objective on the assessment of SDLC processes and products
  • Must have experience in bringing focus and organization to ambiguous situations
  • Must demonstrate creative and strong analytical and problem-solving skills
  • Demonstrates excellent interpersonal skills Must have flexibility and ability to adapt quickly to new situations
  • Must have ability to establish and cultivate strong work relationships
  • Must have clear, concise written and verbal communication
  • Must have demonstrated life-long learning skills
  • Desire to work in a collaborative, fast-paced, entrepreneurial environment
  • Ability and willingness to travel (reasonable travel will be required)
  • Proficient knowledge of Microsoft Word, Excel, and Outlook
  • Must have excellent oral and written communication skills, including the ability to communicate with officials at all levels in government and industry
  • Must have the ability to handle and organize multiple projects and deadlines
  • Must demonstrate a high degree of attention to quality, details, and correctness
  • Ability to work with colleagues in a virtual environment (via conference calls, web meetings, and using digital collaboration tools such as Zoom and cloud document repository)

Physical Requirements and Working Conditions:

  • Must have the ability to travel to client sites
  • Ability to work from a home-based office
  • Must have the ability to work at a computer for extensive periods of time
  • Must have the ability to speak on the telephone for extended periods of time
  • Must have the ability to read (paper or computer screen) for extended periods of time
  • Must have sufficient hand, arm, and finger dexterity to operate a computer keyboard and other Company equipment
  • Must have the ability to be self-driven, work independently and as part of a team

We offer excellent benefits that include:

  • Comprehensive Health and Dental Insurance
  • Retirement Plan
  • Disability Benefits
  • Flexible Work Hours
  • Generous Vacation Program


Think you’ve got what it takes? Apply online at on our website and include an introduction to yourself and your qualifications.

This job post should not be interpreted as all-inclusive; it is intended to identify major responsibilities and requirements of the job. The incumbent may be requested to perform other job-related task and responsibilities than those stated above.

Public Knowledge is an Equal Opportunity Employer


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The Medicaid Subject Matter Expert(SME)


The Medicaid Subject Matter Expert(SME) will provide support in the area of proactive data analysis used toidentify investigative targets in the Medicaid Program. The SME will performfraud, waste and abuse detection, deterrence and prevention activitiesinvolving Medicare and Medicaid providers, suppliers, and other entitiesreceiving reimbursement under one or both of the Medicare and Medicaidprograms. This includes providers,suppliers, and other entities performing under Medicare Advantage, the MedicarePrescription Drug Program (Part D), Medicaid Managed Care, and other programsadministered or operated by CMS or State Medicaid Agencies for Medicare claimsprocessed within the jurisdiction.


· Providesubject matter expertise and technical assistance on matters related toMedicaid policies and regulations.

· Identificationof proactive data studies in the Medicaid program, resulting in identificationof high ROI fraud schemes in the Medicaid program in IL, IN, IA, KS, KY, MI, MN,MO, NE, OH and WI

· Generateinvestigative leads related to trending fraud schemes

· Remaininformed of current Medicaid fraud and abuseissues/schemes through researching reports such as CMS MIG Reviews, OIG StateReports, National Association of Medicaid Directors (NAMD) Briefs and otherresources included in the Medicaid SME Research list

· Identifyand document state program vulnerabilities

· AttendMedi-Medi meetings with external customers

· Ensureconfidentiality of all PHI and sensitive information

· Travelas required for meetings or training

· Performother duties as assigned

Minimumrequired qualifications/skills:

· BA or BS degree

· Minimum of three (3) years of Medicaidexperience is required

· Experience in program integrity or medicalreview

· Excellent oral, written and verbal skills with experiencecompiling data and writing reports

· Ability to work independently with minimalsupervision in a fast-paced environment with strict deadlines

· High proficiency level with Microsoft Excel andWord

· Working knowledge of Microsoft PowerPoint

· Excellent research skills including internetresearch

· Ability to work independently with minimalsupervision

· Must have and maintain a valid drivers licenseissued by state of residence


· Certified Fraud Examiners (CFE) designationand/or Accredited Healthcare Fraud Investigator (AHFI) designation


· None


· Work from Home

OfficeEquipment (if a WFH position):

· A locking cabinet and/or desk appropriate for storingdocuments and electronic media

· A cross-cut or micro-cut (preferred) shredder

· A broadband internet connectionwith minimum download speed of 15MB – 20MB. (Wireless Air Cards are not approved forwork from home use. Free/public wi-fi connections not approved.)

· Telework office connection can be hard-wired direct orWi-Fi connection. Minimum of WPA2 (Wi-Fi Protected Access II); prefer WPA2 +AES. (WPA and WPE are not approved.) Recommended home wireless standards: WirelessG Goes through walls, but Medium speed. (Use if router not visible); WirelessN – Great for Speed, but not effective through walls. (Use if router visible); WirelessAC – High speed, but not effective through walls or distance. (Use if routervisible)

· Separate phone line (can be a cell phone)

· Office equipment (such as laptop and printerwill be provided)


· May require prolonged periods of sitting at adesk.


· Successful candidates will be required to consentto background checks, credit check and other contract related screenings

· Travel may be required, and all travel expenses, if applicable,are reimbursable via GSA standards


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Senior Manager of Medicaid Analytics (Work At Home) – Apply Today Now – Bedford, TX, USA – Bedford



**Overview** **:****This role is an opportunity to build a Data & Analytics team supporting Cigna’s Medicaid business from the ground up. The Medicaid business needs the right leader to build a mature data platform and analytics capability to enable growth. The Medicaid Data & Analytics Lead will translate the Medicaid business’s strategic objectives into a roadmap of tools and capabilities that will use data to help make better business decisions and deliver more personalized business insights. The candidate will assemble a team of data experts and business analytics professionals to deliver a broad portfolio of projects, spanning foundational data capabilities, reporting, analytical tools, population health, and customer insights. They will engage in a collaborative, cross-functional group spanning senior leadership and a variety of functional areas (e.g. operations, clinical management, finance, medical economics, and network).****The right leader will possess a strong degree of creativity, innovation, business and financial acumen, leadership ability, and a core data/analytics skillset. They will also demonstrate a talent for translating between technical and non-technical audiences, as well as a desire to champion a data-driven culture with our business partners.****Responsibilities:****Create a detailed roadmap of new capabilities and timing needed to develop a mature Medicaid analytics function** **Develop a strong perspective on the Medicaid business’s strategic goals** **Build relationships with Medicaid senior leadership and key stakeholders** **Understand the current state of Medicaid data and reporting and the existing gaps for all stakeholders** **Create a project plan to document the proposed approach to closing gaps and meeting stakeholder needs****Build a small team from the ground up to execute on the roadmap** **Lead recruitment for a talented team of data, analytics, and reporting professionals** **Set high standards for talent acquisition to attract a high-caliber team with a balance of skill-sets** **Create a team culture of success, innovation, and ethics****Create a strong data foundation for analytics, in partnership with IT organization** **Develop data views, including internal and external sources, to support automated reporting and more sophisticated analytics** **Document and work to automate existing manual data and reporting processes****Identify and recommend operational, clinical, and network trends and opportunities** **Align with state value-based programs and reporting** **Prepare population health analytics by cohorts or acuity levels** **Identify of data anomalies in network and clinical trends for action** **Support Medicaid business with proactive business analytics that align with state contracts****Lead the development of a management scorecard and a suite of reports to allow business leaders to assess and diagnose key trends** **Build automated reporting on financial performance, medical cost trend, clinical management, and other areas** **Provide insights and commentary on drivers of results****Prioritize and execute on the creation of new analytical tools to provide deeper, more granular insights on customer behavior, provider performance, clinical program outcomes, and other business drivers.** **Consider a variety of analytical techniques to meet business need (e.g. financial models, matched-case control studies, machine learning, etc.)** **Provide ad hoc analysis and insight as needed****Operate in a highly ethical and compliant manner, with attention to the unique regulatory demands of the Medicaid business****Qualifications:****Bachelor’s degree or higher in a quantitative field (statistics, mathematics, computer science, finance, actuarial science, data science, business analytics, or equivalent training)****7+ years of work experience, including experience with health care data and statistical analysis****Prior Medicaid business expertise strongly preferred, particularly with prior work in clinical, network, and/or operations functions****Strong expertise working with complex databases, including advanced SQL skills****Strong business and financial acumen, including knowledge of health insurance financial drivers****Strong customer focus, communication, and management of business partner expectations****Ability to think creatively and put structure around complex problems****Ability to translate business needs into practical applications and solutions****Ability to clearly present findings to a diverse group of teams with varying levels of technical expertise****Prior managerial experience strongly preferred****Location is flexible, including WAH option****About Cigna**Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram._Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.__If you require reasonable accommodation in completing the online application process, please email: … for support. Do not email … for an update on your application or to provide your resume as you will not receive a response._


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Patient Support Representative jobs in HCA Medicaid Eligibility(RCPS) in United States. |

Work From Home

SCHEDULE: Full-time

Do you have exceptional customer service and the ability to plan organize and exercise sound judgment? Do you have demonstrated communication, problem solving and case management skills and the ability to act/decide accordingly?

Now is the time to join our team of motivated and nurturing individuals conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The ideal Patient Support Representative serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management. You should also share a passion for our purpose, “To serve and enable those who care for and improve human life in their community.”

Does this sound like you? If so, APPLY TODAY. See what makes us a fabulous place to work!

Parallon is now seeking a Patient Support Representative

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  • We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe deeply in our team and your ability to do excellent work with us.
  • Your benefits package allows you to select the options that best meet the needs of you and your family. 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.
  • Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment. Ensures appropriate signatures are obtained on all necessary forms.
  • Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
  • Complete and file applications. Initiate 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.
  • Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately. Document progress notes to the patient’s file and the hospital computer system.
  • Participates in ongoing, comprehensive training programs as required.
  • Follows policies and procedures to contribute to the efficiency of the office. Covers and assists with other office functions as requested.
  • All other duties as assigned


Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.



  • High School Diploma or GED or related experience in lieu. College degree preferred.
  • Preferred three years of hospital/medical business office experience with insurance procedures and patient interaction
  • Understanding of patient confidentiality to protect the patient and the clinic/corporation.
  • Ability to collect, synthesize and research complex or diverse information.

We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Notice Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here. For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.


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Medicaid Fraud Subject Matter Expert – Catapult Consultants

Catapult Consultants is now hiring a Medicaid Fraud Subject Matter Expert. The expert will Develop Medicaid and Medicare-Medicaid (Medi-Medi) proactive data analysis for identification of fraud schemes and trends. Provide subject matter expertise and technical assistance on matters related to Medicaid policies and regulations.  Support the Data Analysis, Medical Review, Program Integrity and Request for Information teams by consulting with staff and participating in investigative and/or data analysis efforts. 

Key Responsibilities:

  • Identification of proactive data studies in the Medicaid program, resulting in identification of high ROI fraud schemes
  • Remain informed of current Medicaid fraud and abuse issues/schemes through researching reports such as CMS MIG Reviews, OIG State Reports, National Association of Medicaid Directors (NAMD) Briefs and other resources included in the Medicaid SME Research list
  • Identify and document state program vulnerabilities
  • Attend Medi-Medi meetings with external customers
  • Ensure confidentiality of all PHI and sensitive information
  • Travel as required for meetings or training
  • Perform other duties as assigned

Basic Qualifications:

  • High proficiency level with Microsoft Excel and Word
  • Working knowledge of Microsoft PowerPoint
  • Excellent verbal and written communication skills
  • Excellent research skills including internet research
  • Ability to work independently with minimal supervision
  • Ability to perform multiple priority tasks
  • Associate must have and maintain a valid driver’s license issued by his/her state of residence

Preferred Qualifications:

  • A minimum of three years of Medicaid experience is required, program integrity or medical review experience preferred
  • Preference given to those with experience in IL, IN, IA, KS, KY, MI, MN, MO, NE, OH, WI

Required Education:

  • BA or BS degree preferred
  • Preference given to candidates with Certified Fraud Examiner (CFE) and/or Accredited Healthcare Fraud Investigator (AHFI) designations


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