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General Summary of Position
Responsible for assuring that all regulatory reports for all regulatory agencies are sent to each jurisdiction on or before the assigned due date and performing data quality checks on all regulatory reports prior to submission. This position acts as a liaison between Medicaid and all internal departments and external vendors to interpret and apply Medicaid contract/regulatory requirements. Ensures departmental policies and procedures are compliant with the Medicaid contract and state and federal regulations.
Primary Duties and Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Assures that all regulatory reports for all agencies are sent to each jurisdiction on or before the assigned due date.Performs data quality checks on all regulatory reports prior to submission to ensure accuracy.Serves as liaison between operational departments, government programs administration, compliance department and external customers/vendors.Researches regulatory reporting issues and assists in the development of compliance solutions for new laws and regulations.Monitors the State Medicaid website, communications and contract amendments and interprets and ensures changes or clarifications to relevant implementation departments as necessary.Identifies opportunities for improvement and performs root cause analysis and collaborate with appropriate areas for resolution.Develops and analyzes reports to monitor regulatory reporting compliance and program performance.Develops and maintains dashboard reports to provide insight applying accurate and appropriate interpretation of data.Participates in meetings and on committees as assigned.
Minimum Qualifications
Education
- Bachelor's degree In Healthcare Administration, Project Management, Business Administration or related field required
Experience
- 5-7 years Experience in managed care or healthcare related organizations, with 5 years' experience in project management and/or compliance oversight experience. required
- Technical experience - Excel, SQL preferred
Knowledge, Skills, and Abilities
- An in-depth understanding of national reimbursement mechanisms (CMS-1500, UB forms, ICD-10, PPS, CPT, HCPCS) as well as local regulatory environment.
- Strong understanding of compliance activities around claims, enrollment, call center, utilization management, etc. related data.
- Strong process management and time management skills with ability manage strict competing deadlines and provide oversite to reporting processes.
- Ability to convey verbal and written information effectively.
- Ability to follow verbal and written instructions.
- Verbal and written communication skills.
- Computer skills preferred.
This position has a hiring range of $63,793 - $113,318
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MedStar Health
Dec 23, 2024