Program Integrity Administrative & Technical Liaison
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Job Location:
Cheyenne, WY - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Description and Functions
- Open Until FilledGENERAL DESCRIPTION:
The Medicaid Program Integrity Administrative & Technical Liaison is a contract position and will play a pivotal role in helping maintain the efficient and effective functioning of the Medicaid Program Integrity (PI) section. This role is integral in ensuring efficient Program Integrity operations by providing comprehensive administrative and technical support across multiple functional areas including provider audits & investigations data management and business operations. The incumbent in this role must be detail-oriented capable of multitasking and have a strong grasp of both administrative and technical processes required to support the operational and investigatory needs of the PI Section.
This position will be responsible for:
- Managing the receipt vetting distribution and tracking of telephone and web complaints.
- Oversight and management of the information flow both incoming and outgoing within the PI section.
- Establishing and streamlining document management processes.
- Conducting scheduled and ad hoc reporting as assigned.
- Manage the PI Sections extensive reference library.
Human Resource Contact:
ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level.- Administrative Coordination
- Send receive track and manage certified correspondence related to audits investigations and other PI Section activities.
- Streamline the receipt and data management of information received from providers.
- Receive vet distribute and track telephone and web provider and member complaints/referrals related to potential fraud waste and abuse of Medicaid services.
- Document & Case Management
- Uploading and management of provider data medical records and other data from providers as well as other sensitive information in the sections case management system ensuring accuracy and efficiency in its receipt and organization;
- Evaluate manage and conduct quarterly updates of PIs extensive reference library ensuring that federal and state statutes administrative rules regulations policy manuals bulletins and education materials for providers are current and accessible.
- Conduct scheduled and ad hoc reporting from the fraud waste and abuse case management system and ensure that data is accurate and up to date.
- Functional/Operational Support
- Support the smooth functioning of the PI Section by coordinating meetings deadlines and task tracking for audits investigations and operational activities.
- Manage updates to the PI Sections Process Manual ensuring processes are accurate and up-to-date.
- Support the review and updating of Wyoming Admin Rules that impact PI (Chapter 16 Chapter 4)
- Provide research support for auditors investigators and other team members as required.
- Monitor and report on compliance with Medicaid policies and procedures as well as state and federal regulations by keeping the team informed of relevant updates
- Stakeholder Liaison
- Serve as the main liaison between the PI Section and key internal stakeholders including the Utilization Management Coordinator Benefits and Quality Control Managers BMS contract manager and other relevant entities.
- Disseminate information requests from internal stakeholders to relevant PI staff/leadership.
- Ensure compliance with Medicaid policies and procedures as well as state and federal regulations by keeping the team informed of relevant updates
- Reporting Responsibilities
- Generate regular and ad hoc reports from the fraud waste and abuse case management system;
- Prepare detailed reports for internal and external stakeholders including summaries of findings recommendations and action plans;
- Maintain comprehensive records of all reports and related documentation; and
Qualifications
PREFERENCES:
Preference will be given to candidates with:
Education and Experience:- High school diploma or GED required; associates or bachelors degree in public administration healthcare administration business or a related field preferred.
- Minimum of 3 years of experience in an administrative or technical support role preferably within a healthcare legal or government setting.
KNOWLEDGE:- Strong organizational and multitasking skills.
- Excellent communication and interpersonal skills.
- Experience handling sensitive information with discretion and maintaining confidentiality.
- Proficiency in Microsoft Office Suite (Word Excel) and case management systems.
- Proficiency in data management and reporting tools.
- Ability to work independently and as part of a team to solve problems and streamline operational processes.
- Familiarity with Medicaid healthcare compliance and related regulations is a plus.
MINIMUM QUALIFICATIONS:
None - See PreferencesNecessary 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: Non-Exempt
- The Wyoming Department of Health is anE-Verifyemployer.
- This position is an At-Will Employment Contract (AWEC) and includes a single Health Insurance plan. This position pays for actual hours worked and is limited to 40 hours per week. This position does not include paid vacation time paid sick time paid holidays family health insurance retirement or other benefits. These items are not negotiable by the hiring manager.
Supplemental Information
Click here to view the State of Wyoming Classification and Pay Structure.
Class Specifications are subject to change please refer to the A & I HRD Website to ensure that you have the most recent version.
