Description
***This position has the opportunity to work from home 2 days a week***
BASIC FUNCTION:
This position is responsible for oversight of Medicaid core operation functions (e.g. claims, enrollment, customer service, benefits, appeals/grievances, encounters, reporting) in accordance with contractual and regulatory requirements. Serve as the point of contact with state regulators and coordinate with key functional areas across the organization, local vendors, and 3rd party business partners with the development and implementation of Medicaid Operations. Serve as business lead responsible for implementing HFS regulatory and contract changes (i.e., state fee schedule benefit changes and annual regulatory changes) including process and system changes. Position will also oversee the preparation and management of external audits and be responsible for ensuring compliance with policies and procedures and recommended corrective actions.
JOB REQUIREMENTS:
- Bachelor Degree and 4 yrs operations experience OR 8 years experience working in health insurance operations
- 3 to 4 years experience leading and managing teams
- Experience in project management
- Experience managing operations for Medicaid, Dual Demonstration or other related Medicaid Medicare Advantage programs
- Experience in business planning, time management, project management and organization skills with ability to multi-task and manage multiple, concurrent projects and priorities
- Experience planning and driving business initiatives through implementation
- Possess leadership, communication skills (oral and written) and ability to exercise strong interpersonal skills in varying, cross-functional situations
- PC proficiency to include Word, Excel, PowerPoint and Lotus Notes
PREFERRED JOB REQUIREMENTS:
- Background in administration of contracts for State and Federal Government.
- Experience managing vendor relationships
- Facet knowledge preferred
- Blue Chip knowledge preferred
- Knowledge of call center management and performance monitoring
*CA
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HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.