Job ID: BDP-1040776
This leadership position is responsible for the management oversight of Medicaid core operation functions in collaboration with internal matrix partners and in accordance with contractual and regulatory requirements. Serve as point of contact with internal matrix partners and coordinate with key functional areas across the organization, local vendors, and third-party business partners with the development and implementation of Medicaid Operations across the organization. This position will coordinate as needed with state regulators to ensure that any necessary requirements, information, or resources necessary to the supported operational functions are received. Directs the development of programs, standards and policies and procedures of program changes and works with other areas of the organization to ensure the requirements of the Medicaid program are met. This position will serve as business lead responsible for implementing Oklahoma Health Care Authority (OHCA) and CMS regulatory and contract changes (i.e., state fee schedule benefit changes and annual regulatory changes) including process and system changes. This position is responsible for ensuring BCBSOK Medicaid claims are processed timely and accurately according the Medicaid contract requirements. The role has indirect oversight of the claims department staff, who monitor billing activities, provide technical assistance, and ensure encounter claims submitted are for actual rendered services performed and meet medical necessity.
Position is responsible for managing relationships with local Medicaid vendors.
- 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
- Comfort in working in a dynamic and demanding environment with the potential for rapid change
- 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
- FACETS/TriZetto platform knowledge preferred
- Knowledge of HIPAA X12 Transaction Sets including 837p, 837i, 270/271, 276/277, 834/835
- Knowledge of call center management and performance monitoring
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.
Expertise Government Programs Job Type Full-Time Regular Location OK – Oklahoma City
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