Program Specialist 2 (744668) - TulaRay

Job Purpose:

This position will assist with the development, maintenance, monitoring of the Medicaid Management Information System (PROMISe claims processing system) and enrollment management within the Electronic Client Information System (eCIS). The position will support member enrollment updates and the financial and Managed Cared subsystems to ensure compliance with Department of Human Services regulations, policies and payment timeliness.

Role Description:

· Maintain a general understanding of Medical Assistance program.

· Make updates and corrections for Managed Care (enrollment) based on reports and requests from MCO and other program offices.

· Support MCO capitation by validating payments are made correctly and promptly.

· Correcting payment errors for the capitation unit.

· Identify claims processing system related issues, communicate the issue to both program and technical staff.

· Work with technical staff to resolve issues and verify that the system issue has been resolved.

· Identify and share systematic changes that could possibly lead to increased productivity for state staff or business partners.

· Conduct business meetings including devising an agenda, leading discussions, documenting follow-up items, and preparing file notes for distribution to attendees.

· Use a variety of software packages to develop queries and prepare reports for analysis of reimbursement accuracy.

· Perform other related duties, as assigned.

Minimum Qualifications:

One (1) year of professional experience in developing, implementing or evaluating human services, sociology, public health, health care services, or health care insurance programs; and a bachelor's degree in Human Services or Education Field; or Any equivalent combination of experience and training that includes at least one (1) year of professional experience in developing, implementing or evaluating human services, education, sociology, public health, health care services, or health care insurance programs.

Intermediate Computer skills to include, but not limited, to Microsoft Office Products.

Role Description:

· Respond, either verbally or in writing, to select inquiries from intra and interdepartmental units, outside entities, and family/applicants.

· Coordinates the development and maintenance of information technology to support program operations and monitor the tracking systems.

· Reviews and recommends modifications to program manuals and materials based on policy revisions.

· Develop and update forms and files.

· Coordinates the collection of Data to prepare reports.

· May be Involved in provider recruitment, enrollment, dis-enrollment and outreach activities.

· May be Involved in incident reviews, closing incidents, reports and investigations. May be involved in fair hearing preparation.

· Participates in trainings, meetings, and conferences on behalf of the Bureau as assigned.

· Assist in tracking information, reviewing reports, and preparing reports for the supervisor, CMS and Agency when needed.

· The employee will use HCSIS and CIS for screening, entering information, and researching information when needed.

· The employee may assist in monitoring of services provided to participants of autism programs.

· Other related duties as required.

Other Helpful Qualifications

o Demonstrated problem solving skills, strong conceptual and analytical skills, including the ability to analyze and interpret data and trends

o Demonstrated teambuilding skills, proven ability to interact at all levels of the organization.

o Ability to analyze policies and contracts and apply to compliance requirements

o Excellent organizational and strategic planning skills

o Ability to think and work independently

o A working knowledge of Medicaid/Medical Assistance

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com