Program Specialist 2 (780640)

Job Purpose:

The Program Specialist 2 position within Bureau’s Division of Medicaid Management Information System (MMIS) Operations, will report to the Eligibility, Enrollment and Capitation (EEC) Unit. The position will support the financial and Managed Care subsystems to ensure compliance with Department of Human Services regulations and policies, will support managed care programs (i.e. HealthChoices and Community HealthChoices) administered by the Office of Medical Assistance Programs, including working with providers and the Managed Care Organizations (MCOs) to ensure recipient eligibility and managed care enrollment are accurate.

Role Description:

Eligibility Unit

• Review and update forms, calendar, and file schedules on extranet.
• Received and process CAO notification forms received from MCO as needed.
• Prepare system notices as requested.
• Download, import and query Facility/Waiver database from Mainframe. Distribute reports as needed for processing by other units.
• Review OIM intranet for daily statuses, memos, bulletins and Operations Memo updates and changes’
• Coordinate reports being distributed related to MA Recidivism.
• Review requests received related to Enrollment Verification System.
• Make updates and corrections for Managed Care based on reports and requests from MCO and other program offices.
• Participate in testing of Electronic Client Information System after system releases and system updates.
• Review MCO alert file submissions.
• Review and complete monthly reports identifying capitation discrepancies related to newborn MA recipients.
• Review and complete monthly report identifying capitation discrepancies related to dates of deaths on MA records.
• Review requests to update recipient information related to Medicare.

Minimum Qualifications:

Licensure/certification requirements:

• Bachelor’s Degree or equivalent experience

Experience required:

• At least 2 years of healthcare industry experience, preferably with a health plan
• A working knowledge of healthcare operations preferably: billing/payments, customer service, claims/capitation processing, provider and reference files,
• Applied analytical skills
• Strong written and verbal communication skills
• Proficiency in Microsoft Office Suite, including Access, Excel, PowerPoint and Word
• Proven ability to successfully complete both short and long-term assignments
• Ability to lead meetings and/or presentations

Other Helpful Qualifications

• Demonstrated problem solving skills, strong conceptual and analytical skills, including the ability to analyze and interpret data and trends
• Demonstrated teambuilding skills, proven ability to interact at all levels of the organization.
• Ability to analyze policies and contracts and apply to compliance requirements
• Excellent organizational and strategic planning skills
• Ability to think and work independently
• A working knowledge of Medicaid/Medical Assistance

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