Benefits Quality Control Manager

Cheyenne, WY - USA

Monthly Salary: USD 6171 - 6171

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

Description and Functions

Open Until Filled

GENERAL DESCRIPTION:

Manages and oversees provider and benefit management functions for approximately one-third of Wyomings statewide Medicaid program. Oversight includes provider coverage and billing policies reimbursement methodology claims payments and provider services monitoring expenditure management and communication for a program that comprehensively pays over $500 million annually. Successful management and oversight will require ongoing collaboration between the Division of Healthcare Financing and the Centers for Medicare and Medicaid (CMS).

Human Resource Contact:

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed in the job level.

Draft and implement program State Plan Amendments (SPA) rules and policies governing coverage and reimbursement of the following provider/service types: Dentists Immunizations Hospital providers including Psychiatric Critical Access Ambulatory Surgical Care Diagnosis-Related Groups for hospital payments (DRG) Hospital Outpatient Prospective Payment System (OPPS) and Rehabilitation Hospitals.
Serve as the Wyoming Medicaid subject matter expert and contact person for benefit and reimbursement questions related to the following provider types/services: Dentists Immunizations Hospital providers including Psychiatric Critical Access Ambulatory Surgical Care Diagnosis-Related grouper for hospital payments (DRG) Hospital Outpatient Prospective Payment System (OPPS) and Rehabilitation Hospitals.
Participate in and lead medical and dental association meetings national meetings/trainings representing Wyoming Medicaid. Attend weekly/monthly/quarterly meetings with other Medicaid programs and Agencies within the federal government and providers.
Plan implement monitor and evaluate program performance goals and objectives for the Departments larger performance management program.
Provide ongoing contract management for the Orthodontic review contract.

Qualifications

PREFERENCES:

The training and experience equivalent to a bachelors degree in public administration business accounting healthcare administration political science or other closely related field with three years of professional work experience in business accounting political science healthcare or public administration.

KNOWLEDGE:

State government functions and procedures including State and federal laws policies and procedures.
Medicaid law and regulatory structure including State and federal Medicaid statutes regulations and policies.
Knowledge of accounting budgeting and data analysis.
Concepts principles and practices of professional healthcare administration; challenges and trends in healthcare service provision.
Contract procurement negotiation and administration.
Accounting and budgeting in government.
Legal requirements and procedures relating to rule promulgation.
Administrative fair hearing process; citation and interpretation of complex legislation
Program and time management coaching and leading. Ability to balance multiple priorities and resources.
Interpersonal relations team building and consensus building.
Goal setting performance evaluation and individual motivation.
Research and analysis of complex problems as well as identification of options and solutions; decision making and evaluation of results.
Public speaking oral and written communication at a variety of levels and with multiple audiences
Coordinate and motivate individuals and teams to undertake complex projects and achieve specific goals.
Balance numerous demands on time using available resources.
Ability to plan and analyze conceptualize and communicate data analysis effectively.
Quickly identify problems prioritize needs research solutions and make decisions.
Design and implement policies and processes in a timely responsive and cost-effective manner.
Understand complex budgets federal fiscal match and how they apply to coverage and payment programs.
Coordinate complex integration of unique program and system interfaces.
Research and analyze issues related to Medicaid claims processing and payments or to coverage and reimbursement policies under Wyoming Medicaid.
Understand technology as it relates to Medicaid claims processing.
Make decisions in the absence of the Provider and Benefits Management Unit Administrator.

MINIMUM QUALIFICATIONS:

Education:

Bachelors Degree (typically in Healthcare)

Experience:

1-2 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist

Education & ExperienceSubstitution:

4-6 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist

Certificates Licenses Registrations:

None

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

The employee may sit comfortably to perform the work; however there may be some walking standing bending carrying light items driving an automobile etc.

NOTES:

FLSA: Exempt
The Wyoming Department of Health is anE-Verifyemployer.

Supplemental Information

Clickhere to view the State of Wyoming Classification and Pay Structure.

URL: State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change please refer to the A & I HRD Website to ensure that you have the most recent version.

Required Experience:

Manager

Description and FunctionsOpen Until FilledGENERAL DESCRIPTION: Manages and oversees provider and benefit management functions for approximately one-third of Wyomings statewide Medicaid program. Oversight includes provider coverage and billing policies reimbursement methodology claims payments and pr...