Job ID: DLP-1034498
This position is responsible for leading HCSC's Illinois Medicaid encounter reporting activities and functions. Operational areas of responsibility include encounter data management, submissions; reject remediation, vendor management, as well as, interfacing with state regulatory agencies. This individual must be experienced in managing day to day Medicaid encounter operations and submissions.
Oversees encounter data collection, processing, submission and data reconciliation efforts ensuring that collected data is processed and submitted according to State guidelines and requirements.
Directs the operations of encounter data aggregation processing and submission by coordinating and overseeing staff prioritizing tasks and resolving issues as they occur.
Analyze encounter data to identify trends, and conduct root cause analysis; develop improvement plans, organize cross-functional teams and develop high-quality output for internal and external constituents to address identified issues
Oversees encounter data vendor relationships by monitoring their performance and guiding them through issues and priorities
Develop and execute action plans to respond to new encounter regulatory requirements
Leads staff assigned to Medicaid encounter reporting, provides guidance and engagement of staff; and builds effective teams (both internally and with vendors) to achieve established goals.
Maintains expert knowledge of IL Medicaid encounter reporting requirements, including regulatory changes impacting the program
Serves as a Subject Matter Expert for other department, providers and committees
Build and maintain relationships with leadership at all levels to build credibility and crucial support for the business' process, methodologies and technologies
Performs any other job-related duties as assigned.
Required Job Qualifications:
Bachelors or Advanced degree in Business Administration, Finance, Statistics, Healthcare Administration and minimum of 6 years of experience in Medicaid managed care
Experience with IL Medicaid encounter management ,reporting and requirements
Knowledge of Medicaid Encounter Data System & understanding of 837 I & P file formats
Experience in Vendor management, SLA enforcements, negotiations
Ability to create presentations & exhibits for executives
Strong interpersonal, organizational and workflow skills
Willingness and ability to travel 25
Preferred Job Qualifications:
Experience with encounter file preparation and remediation.
Experience with databases as well interpretation and manipulation of related data.
Knowledge of other managed care products including Commercial Exchange and Medicare Advantage, TX Medicaid
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Other, Government Programs Job Type Full-Time Regular Location TX - Richardson, IL - Chicago