Process Expert II (Medicaid)


Description SHIFT: Day JobSCHEDULE: Full-timeSupports a single operations department by participating in project and process work. Primary duties may include, but are not limited to: Research operations workflow problems and system irregularities; develops tests, presents process improvement solutions for new systems, new accounts, and other operational improvements; develops and leads project plans and communicates project status . Qualifications Requires a BA/BS degree and 5 years of experience including 3 years of progressively responsible audit experience, leadership experience or any combination of education and experience which would provide an equivalent background: Proficiency in WGS, NASCO, and Facets ACES and CS90 experience also preferred Proficiency in Commercial and Medicare Working knowledge of COB prevention, data match, claims edits and inquiries team processes Strong verbal and written communication skills Proficiency in Coordination of Benefits experience, which includes detailed working knowledge of NAIC guidelines, CMS primacy rules, and claim coordination methodology Basic understanding of statistics; thorough understanding of different audit methodologies, in-depth knowledge of multiple systems and proven understanding of processing principles, techniques and guidelines; excellent organizational, project management, analytical, leadership, verbal and written communication skills required. REQNUMBER: PS52327

14 hours ago


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