SCOPE OF POSITION:Provide communication, education, and promotion of the program services. Have a clear understanding of contract deliverables and collaborate with other professional staff to meet the contract deliverables within designated timeframes. Responsible for identifying problems or issues with client records. Researching the cause of an issue and correcting by updating the client’s records to support the correction and linking of client records as needed within the appropriate system to correct system errors. Familiarity with Medicaid Policy and Medicaid website pertaining to the issues being researched. Serve as a subject matter expert for AIRES CURAM, Docushare, Aria, Answer and MMIS. Provide superuser access and training to Interchange. Responsible for collaborating with Medicaid Managed Care Service (MMCS) staff regarding clients and medical providers, ensuring timely provision of services and, responsible for providing appropriate follow-up and documentation of services rendered in the system designated by AFMC’s IT department, DHS and DXC. Must have knowledge of all technical software required to complete the processes and to appropriately complete the requirements of the contract deliverables. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS:

1. Onsite presence required at DHS.
2. Serve as onsite contact for state agencies.
3. Change Qualified Health Plans (QHP) plans for clients through Interchange superuser access if assistance is required.
4. Update State systems when receiving requests for clients to change categories. 
5. Carrier (Vendor) File Requests which are from client, Provider, Insurance Agent or plan to verify with the carrier they have the client’s enrollment file. 
6. Creating tickets for Data Fixes needed in the system with DXC/Gainwell.
7. PASSE requests, including plan changes, carrier file requests, adoption linking requests and address changes. 
8. Client inquiry request sent to the state’s beneficiary inbox. 
9. CURAM Support Log (CSL) Linking requests, demographic updates (Name, Address, DOB, SSN), history of segments in interchange, update segment start and end dates.
10. Pharmacy Requests involving link verifications, carrier files or Rx claim issues. 
11. Resolving escalated requests from Governor’s office. 
12. Special duties assigned by Medicaid Director, Medicaid Assistant Director DHS/DMS/DCO. 
13. Assist in the management of timelines for projects taking into consideration contract deliverables, member needs, department workload, resource/capacity constraints and vendor capabilities.
14. Assist in the coordination and development of tools in collaboration with the project team and communications for providers and consumers about project goals.
15. Serve as back up for other support staff as required.
16. Assist with incoming members requests for information. Research issues and determine the appropriate party or course of action to address the request for resolution. Maintain a database of all calls received and actions taken.
17. Understand and utilize project-tracking software for reporting purposes. Perform data entry into both internal and/or external program databases.
18. Daily quotas may be added to meet contract deliverables as needed.
19. As required, compose, edit and assist in creating communications and/or materials for projects.
20. Communicate effectively with all internal and external customers.
21. Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
22. Perform data entry, organize, file and maintain departmental records, manuals and correspondence.
23. Maintain a general working knowledge of department / contract deliverables.
24. Assist in the review, verification, and editing of work produced by other staff members as directed.
25. Additional duties as assigned. 

KNOWLEDGE, SKILLS AND ABILITIES:

• Intermediate skill level with MS Office (Excel, Word, PowerPoint, and Outlook).
• Type 50 wpm.
• Strong skills in business English and spelling.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Strong public speaking skills.
• Ability to train existing or new staff members.
• Creativity and flexibility.
• Ability to meet deadlines.
• Attention to detail.
• Ability to delegate as required.
• Understanding of terminology used within the specific area of responsibility.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients and the public.
• Ability to handle and react calmly under stressful situations.
• Knowledge of regulations and requirements pertaining to the assigned area of responsibility.
• Ability to multitask.
• Ability to prioritize.
• Strong organizational and problem-solving skills.
• Professionalism.
• Customer Service.
• Ability to read, interpret and apply laws, rules and regulations.
• Time management skills.
• Regular and punctual attendance.
• Ability to work overtime as needed.

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to lift and transport 30 pounds. Must be capable of performing the essential functions of this job, with or without reasonable accommodations.

EDUCATION:Required: High School Diploma
Desirable: Associate degree or additional education

EXPERIENCE:Required: Two (2) years of Medicaid experience. One (1) year of research experience. Prior experience with Medicaid Systems (MMIS, CURAM, AIRES and Answer).
Desirable: Prior Medicaid billing experience.