Category: Uncategorized

 
 

The Office of Health Affairs are West Virginia University is seeking applications for a Medicaid Claims Data Specialist (Research Associate) located in Charleston, WV. The Medicaid Claims Data Specialist is a key participant in the State-University partnership between the West Virginia University Office of Health Affairs and the West Virginia Department for Health and Human Resources (WV DHHR). Overarching responsibilities include implementation and management of a data science training program to assist faculty and staff at Office of Health Affairs in analyzing administrative Medicaid claims and other state data sources. This position will also be responsible for working with the WV DHHR to leverage data resources and support analytic needs, overseeing the use of state data sources for research at West Virginia University, participating in interdisciplinary research and evaluation teams, and providing oversight and management of other data analysts and personnel embedded within the Department for Health and Human Resources. The Medicaid Claims Data Specialsit will be an employee of the West Virginia University Office of Health Affairs, however, this individual will be embedded within the Department for Health and Human Resource’s Bureau for Medical Services and will work full-time out of the Office of Health Affairs offices in Charleston, West Virginia.

In order to be successful in this position, the ideal candidate will:

• Provide training in the analysis of administrative Medicaid claims data using SAS or other statistical analysis packages to other faculty, staff, and students at West Virginia University
• Serves as a University representative and liaison to the West Virginia Department of Health and Human Resources for the planning and performance of projects, programs and activities involving health data analytics and program evaluation.
• Oversee data governance and data stewardship for the West Virginia University Office of Health Affair
• Manage a standardized data science training program for faculty and staff in the West Virginia University Office of Health Affair
• Work as part of a team to advance the partnership between the West Virginia University Health Sciences Center and the West Virginia Department of Health and Human Resources
• Oversee and conduct analyses of Medicaid claims data and other state data sources at the direction of leadership within the Office of Health Affairs or Department for Health and Human Resource
• Support both West Virginia University faculty as well as leadership within the Department for Health and Human Resources in using Medicaid claims data as well as other state data sources to answer research questions of interest to the stat
• Manage the use of state data sources for independent research by faculty, staff, and students at West Virginia University
• Ensure that data analytic and research/evaluation activities are compliant with University-level policies for the responsible conduct of research as well as federal, and state policies.
• Provides consultation to faculty and government partners regarding preparation of research proposals, design and methodology, data analytics and interpretation of results
• Conduct or direct special projects as assigned.
• Act in other matters and capacities as delegated by leadership within the Office of Health Affairs
  
   

Qualifications

• PhD in health or data science-related field; or equivalent amount of combined education and work experience.
• Two (2) years experience
• Record of research and achievement in health outcomes and policy research (health services research, public health informatics, health policy, clinical outcomes) as evidenced by publications and / or sustained involvement in a research program.
• Experience conducting research/evaluation using large administrative claims data sources within the healthcare industry or academic or governmental sectors
• Experience training and managing other data analysts
• Extensive knowledge and experience in utilizing large administrative claims databases for research, program evaluation, and policy development.
• Experience training others in how to analyze administrative claims data using SAS or other statistical package
• Proficiency in the use of standard statistical analysis packages such as SAS or
• Ability to project and maintain a positive and collaborative attitude
• Record of accomplishments in the area of health data analytics.
• Experience managing other data analyst
• Strong ability to communicate goals, methods, and results of research initiatives with key stakeholders
• Proficiency presenting the results of data analyses to diverse groups of stakeholders
   

Requirements

• Valid driver’s license and ability to travel
   

About WVU

At West Virginia University, we pride ourselves on a tireless endeavor for achievement. We are home to some of the most passionate, innovative minds in the country who push their limits for the sake of progress, constantly moving the world forward. Our students, faculty and staff make this institution one of the best out there, and we are proud to stand as one voice, one university, one WVU. Find out more about your opportunities as a Mountaineer at http://hr.wvu.edu/.

West Virginia University is proud to be an Equal Opportunity employer, and is the recipient of an NSF ADVANCE award for gender equity. The University values diversity among its faculty, staff, and students, and invites applications from all qualified applicants regardless of race, ethnicity, color, religion, gender identity, sexual orientation, age, nationality, genetics, disability, or Veteran status.
 

Job Posting: Dec 10, 2020

Posting Classification: FE/AP

Exemption Status: Exempt

Benefits Eligible: Yes

Schedule: Full-time

Clipped from: https://www.glassdoor.com/job-listing/medicaid-claims-data-specialist-research-associate-health-affairs-careers-west-virginia-university-JV_IC1143753_KO0,65_KE66,98.htm?jl=3768151460&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Medicaid and MCO Coordinator

Updated 3 days ago

Help at Home
Chicago, IL 60602
 

Full-time

Similar jobs pay $9.25 – $15.36
 

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Help at Home is still hiring in your community!

Help at Home is the nation’s leading provider of high-quality support, providing a gold standard of care to seniors and people with disabilities.  

Right now, our clients need us more than ever. We are still hiring compassionate caregivers, and we are taking every precaution to protect our communities.

We commit to being transparent and open in our hiring process to ensure your health and safety. Our clients, caregivers and employees will always be our top priority.

Help at Home seeks an experienced Medicaid and MCO Coordinator. In this role, the ideal candidate will be responsible for the administration of all Help at Home Medicaid revalidations and Manage Care Organization (MCO) credentialing functions.  
 
The Medicaid and MCO Coordinator coordinates all aspects of Medicaid revalidations and MCO credentialing. He/she will ensure all renewals are completed accurately and timely. The Medicaid and MCO Coordinator will work closely with all key stakeholders within the Business Development department and with Regional Vice Presidents to ensure all Medicaid revalidations and credentialing are completed per state regulation. Additionally, the candidate will have a solid understanding of Medicaid revalidation and MCO credentialing policies and procedures. The ideal candidate will also be responsible for key reporting, managing key metrics, monitoring due dates, and developing presentations to provide business intelligence.  

 
 

Responsibilities

• Ensures all Medicaid revalidation is maintained and renewed accurately and timely
• Ensures all MCO credentialing is maintained and renewed accurately and timely
• Continued communication with Regional Vice President’s and Medicaid/Managed Care plans for follow up on licensure, applications, (effective dates/terminations), demographic changes, etc.
• Maintains positive and professional relationships with all providers, field questions and collect data from supervisors, managers, directors, outside vendors, Interact on a project/consistent basis with various departments
• Problem solving and troubleshooting as needed
  Stays abreast of provider recruitment and strategic partnership opportunities
• Maintains spreadsheet on current credentials including, user identification and passwords, NPI numbers, State, and expiration dates, effective dates for each Medicaid Provider ID and MCO credentialing period
• Maintains Medicaid revalidation and MCO credentialing trackers in smartsheet
• More responsibilities will be added per business needs

 
 

 
 

Qualifications

• Bachelor’s degree in a related field
• Minimum of three (3) years of Medicaid Waiver enrollment/revalidation and/or MCO provider credentialing experience
• 15 % or occasional travel required (adjust as needed)
• Comprehensive knowledge of data sets and analytics
• Proficient in Microsoft Office Suite
• Experienced in smartsheet
• Exceptional presentation and reporting skills
• Strong research and analytical abilities
• Able to work independently, and efficiently with a minimal amount of oversight
• Excellent oral and written communication skills
• Experience in working within the non-medical home care or home health care sectors is strongly preferred
• Ability to work well within a diverse team and across departments
• Flexibility to adapt to a fast-paced and dynamic work environment
• Ability to multi-task, organize and meet deadlines
• Personal attributes include initiative, discretions, sound judgment, collaborator, positive behavior and performance

 Clipped from: https://www.snagajob.com/jobs/603815336?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Working remotely within the United States is acceptable for this position.

What you will do:

Oversees one or more software products end-to-end and assists in the direction of particular project-level activity and associated team personnel.
Works under general supervision.
Maintains relationship with client, project scope can increase in complexity and size.
Manages client relationships at the client customer work site.
Provides project management for prime or sub-contractor, fixed price, or time and materials projects.
Provides project management on projects with a team size that is up to 100 employees concurrently.
Provides project management on projects with annual total contract value of up to $50M and complexity (hours) of up to 300,000 hours.
Provides end-to-end responsibility for one or more products, sub-systems or level responsibilities.
Develops detailed, resource loaded project schedule with the required metrics.
Confers with project personnel to provide technical advice and to resolve problems.
Manages project risk by working with project schedulers to track project schedules, deliverables, and milestones; monitors costs and schedules using EVM and other tools.
Oversees and develops a feasible plan for one or more software products that achieves the goals and objectives of the project and aligns with the organization’s overall business strategy.
Assists in developing a feasible plan that achieves the goals and objectives of the project and aligns with the organization’s overall business strategy.
Determines project scope and recommending and assigning resources as available.
Determines estimated time and financial commitment of project, and in monitoring progress.

General:

Implements, maintains, and reports Earned Value (EV) metrics into project plans.
Implements, maintains, and reports CNSI project delivery metrics into project plans.
Assists in monitoring and developing a project budget and tracking actual spend compared to the planned budget, escalating to senior leadership as needed.

Customer:

Partners with customers and analyzes issues and problems from the customer perspective.
Provides customer-facing presentations on quality.
Communicates and provides status to define, schedule, and accurately estimate the task duration for project schedule.
Possesses unwavering commitment to customer service and operational excellence.
Keeps abreast of new technology and market developments.
Adheres to CNSI CMMI standards and processes.
Manages internal customer relationships for long-term corporate success

Talent Development:

Requests and gives both negative and positive feedback.
Recruits highly skilled, motivated leaders and individual contributors and recommends potential new hire resources to meet client commitments in alignment with program delivery.

Project:

Familiarity with medical bill and provider enrollment forms.
Identify reoccurring problems and provide feedback to management to affect change.
Familiarity with payment adjustments, claim disputes, prior authorization, claims processing,
Manage sensitive data in accordance with HIPAA and Medicaid regulations.

About us:

We are proud to be a partner to the public sector, a trail blazer in health IT and a passionate advocate for better health, better care and lower costs for millions of Americans. Innovation is core to our DNA and through our iCare program we invest in the well-being of our employees and the communities in which we live and work. You will be offered a solid compensation package which includes:

• Annual and Other Paid Leave
• Medical/Dental Insurance
• Flexible Spending Account (FSA) Plan
• Disability Insurance (Short & Long Term)
• Life Insurance
• 401(k) Retirement Savings Plan
• Employee Assistance Program
• College Savings Plan
• Tuition & Training Assistance
• Paid Holidays
• Employee Referral Program

CNSI maintains a policy supporting equal employment opportunity. Employment decisions at CNSI are made without regard for race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status or any other status protected by applicable Federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

#LI-CV1

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35©

Clipped from: https://motherworks.com/job/995231/project-manager-medicare-medicaid-or-healthcare-verticals-remote-position/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Chicago, IL, USA | America’s Health Insurance Plans (AHIP)

The Director of Finance Medicare/Medicaid, County Care provides leadership and oversight for the Cook County Health’s strategic plan for Medicaid and Medicare products. This includes, but is not limited to, responsibility for County Care financial reporting, driving medical cost action planning processes and execution to achieve established goals and targets. Assists in hiring and managing County Care Finance Department Staff. Work with the Director of Finance to create an innovative department, which is in alignment with and supports the Cook County Health’s mission statement and strategic plan.

This position is exempt from Career Service under the CCH Personnel Rules.

 
 

Minimum Qualifications

 
 

* Bachelor’s degree from an accredited college or university (Must provide official transcripts at time of interview)

* Five (5) years of managed care health plan finance experience

* Two (2) years of management experience

* Current knowledge of Medicare and Medicaid programs, rules and regulations

* Intermediate proficiency with Microsoft Word and Excel

 
 

Preferred Qualifications

 
 

* Master’s Degree in Finance, Economics, or other related quantitative field (Must provide official transcripts at time of interview)

Clipped from: https://www.ivyexec.com/job-opening/director-of-finance-medicaremedicaid-countycare-finance/chicago/illinois/usa?job_id=8061643&ref=ccjsv&promo=ccjsv&ccuid=29504120317
 

 
 

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