Description of Work/Duties:

Consultant will:

Be available as a full time consultant approximately 37.5 hours per week;

Possess a bachelor's degree, health related cerification or a combination of education and experience. Possess a documented work history of two or more years of experience performing a provider relations, health care program monitoring, network management, demonstrate a basic understanding of medical terminology, and administration or medical related call center experience.

The consultant will perform the following duties:

1. Works on projects related to Affordable Care Act (ACA) compliance in the division including new initiatives and implementation of federal and state policies affecting the provider enrollment process.

2. Research and respond in writing to questions and complaints or inquires on enrollment related issues received from providers, legislators, provider associations or legal service organizations. Preparation of response requires research and a thorough understanding of MA program policies and enrollment procedures and an understanding of the department’s enrollment system. Responses areprepared for the Secretary, Deputy Secretary, Bureau Director and Division Director.

3. Research enrollment applications that have "failed" state or federal checks to determine the reason and communicate this information to the appropriate party.

4. Serve on interdepartmental workgroups responsible for development and implementation of new department initiatives or for developing procedures to ensure compliance with new federal or state law, regulations or policies.

5. Provides technical assistance and recommendations to program office staff on complex enrollment issues and sensitive/high profile situations based on policies and regulations to ensure timely, accurate and complete resolution to enrollment related problems.

6. Participates in the development and revision of the Department’s provider enrollment system to ensure that enrollments are processed and providers paid in a timely, appropriate fashion.

7. Responsible for the timeliness and accuracy of information posted to the Department’s websites relating to provider enrollment. Suggest and make changes to provider enrollment policies, procedures, enrollment applications etc. as directed by the Division Director or Supervisors.

8. Attends and participates in meetings with Directors as necessary to provide technical assistance and ensure compliance with overall Department goals and objectives. Maintains and distributes file notes.

9. Develops and writes Quick Tips, Change Orders, Business Requirement Documents, Data Maintenance Requests, Medical Assistance Bulletins, remittance advice alerts and other material to disseminate new or revised enrollment policy and procedures.

10. Reviews unique or specialized provider applications and enrolls them as appropriate.

11. Maintains Departmental Reports ensuring timeliness by tracking completion dates.

12. Monitors Provider hotline, tracking call time and service outcome in a database. Reports Provider hotline tracking to the supervisor.

13. Answers Department internal hotline calls by responding to the calls, directing callers, making referrals and maintaining a log of call outcomes in the database. Reports monthly to the supervisor.

14. Completes monthly Bureau of Fee-for-Service report by compiling statistical information, data entering on the report grid and summarizing division activities/goals/outcomes/plans. Submits report to supervisor for final review.

15. Supports the Healthy Beginnings Plus (HBP) program: completes HBP correspondence, credentials providers for participation, evaluates and scores applications, maintains program indicators in the system, answers calls from providers and directs callers, assists with quarterly news letters, maintains and updates providers in the database.

16. Completes data entry into the authorization system for services requests and appeal adjudication.

• Completes medical record chart requests.

• Files and maintains medical records.

• Purges medical records for filing and records retention.

• Maintains logs of cases requiring physician teleconference.

• Receives and distributes Departmental faxes.

• Completes report regarding cases requiring authorization that have not yet been completed. Submits report to supervisor and distributes to staff.

• Distributes cases for medical review to assigned staff.

• Completes prior authorization notices regarding cases determination as needed.

Consultant will perform other related duties as assigned by the Division Director or Division Supervisor.

Consultant, when requested, will work at one or more of the Department’s work sites. Consultant will be provided with a desk, computer, phone, and all items necessary for him/her to complete assignments.

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