5 - 7 years experience • Business Services
Medicaid Department. General Purpose: Leadership; problem resolution; critical thinking; auditing; relationship and team building; process development and improvement
Essential Duties and Responsibilities:
* Work with Human Resources staff to recruit, interview, select and hire for the Medicaid Department.
* Coach, mentor and develop staff, including overseeing new employee onboarding and providing development and education opportunities for the Medicaid Department.
* Lead employees to meet the organization's expectations for productivity, quality, and goal achievement.
* Plan and allocate resources to appropriately staff each assignment.
* Evaluate and improve departmental operating procedures to enhance speed, quality, efficiency and financial results.
* Review performance data to monitor and measure departmental productivity, goal achievement, and overall effectiveness.
* Review insurance contracts and Medicaid Provider Manuals to gain thorough understanding of payment methodologies.
* Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports, electronic tools and supporting documentation.
* Contact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of client.
* Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting.
* Maintain regular contact with necessary parties regarding project status including payors, clients, managers, and other company personnel.
* Build strong, lasting relationships with clients, payors and company personnel.
* Organize, prepare and/or attend department, client and company meetings.
* Comply with federal and state laws, company policies and procedures. Essential Skills and Experience:
* Minimum 5-years Management experience
* Minimum 2-years Healthcare related experience
* Excellent interpersonal skills with proven ability to motivate and lead a team
Bottom line requirements we need notes on with candidate submittal:
1. 5+ years of Management experience.
2. 2+ years of Medicaid related experience
3. Strong communications and presentation skills.