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Department
Design and Covered Services
Job Summary
Job Description
Monitors the activities of the Provider Enrollment (PE) Unit of the Fiscal Intermediary (FI) and responsible for the monitoring the enrollment and maintenance of over 100 provider types inclusive of over 65,000 providers.
Monitors activities of the Medicaid Provider Subsystem to ensure continued compliance with federal and state regulations, legislative or independent audit findings.
Recommends criteria for implementing activities for the closure and removal (nonparticipating or no activity in eighteen months) of inactive files on the MMIS provider subsystem.
Interfaces with agency bureaus/offices, contractors (such as Office of Behavioral Health, Health Standards, and Managed Care Organizations) as well as state teaching facilities to implement eligibility of certain provider types whose enrollment requirements are more complex and require extended time.
Monitors current and proposed state and federal regulations and clarifications for Impact on present program/system functions.
Meets and/or communicates with federal regulatory agencies, fiscal intermediary staff, providers, and program staff on program/system changes, enhancements and integrity.
Attends meetings to coordinate implementation of policy changes which affect providers.
Participates in strategy development with the fiscal intermediary to formulate and implement such changes.
Assist and participate with the development and implementation of the new Provider Management Project. Serve as the Provider Enrollment “Subject Matter Expert”.
Monitor and assist the Fiscal Intermediary with the day-to-day operation of PE.
Act as liaison between LDH staff and the Fl for design changes, ECHOS, issues with file and/or form discrepancies and special request as it arises.
Consult with and keep LDH management abreast of new developments, major changes and or issues.
Consult with internal staff and external agencies regarding Provider Enrollment issues. Assist with procedures to maintain PE compliance with the Affordable Care Act (ACA) mandates.
Coordinate, participate, review and approve the revisions made to the enrollment applications, forms, and manual.
Research, develop and/or direct small Medicaid projects as assigned.
Assist the Program Integrity staff regarding the enrollment files, for compliance purposes.
Assist Program staff with the creation of new provider types and packets.
Participate in provider workshops, seminars and or training, as requested.
Monitor the PE stats produced by the Fl.
Monitor the Fl for compliance regarding their contractual obligations.
Other duties as assigned.
QUALIFICATIONS
REQUIRED:
Bachelor’s Degree, or Associates degree with 3 years professional experience, or 6 years professional experience in lieu of the degree.
Excellent analytical skills, effective organizational and time management skills.
Great attention to detail and follow up.
Ability to manage projects, assignments, and competing priorities.
Proficient in the use of Microsoft Office, including but not limited to Outlook, Word, and Excel.
DESIRED:
Advanced Degree.
Minimum 1 year professional experience in healthcare compliance auditing, provider enrollment, or credentialing.
Minimum 1 year professional experience working with Medicaid program support.
Minimum 1 year professional experience with claims processing and billing.
CPT, ICD-9 or ICD10 coding and HCPCS knowledge.
SALARY: 42-52k
Required Attachments
Please upload the following documents in the Resume/Cover Letter section.
Detailed resume listing relevant qualifications and…