Ensures system compliance (for example, complying with state-mandated requirements for e-billing) by researching data requirements; updating and maintaining file formats, data reporting fields, and eligibility requirement for all states; monitoring rejection reporting for compliance reasons; coordinating vendors and Information Systems Division (ISD) to ensure programming requirements are met; securing approval for process improvement recommendations; working with ISD to ensure projects are completed by deadlines; and testing and verifying applications and business processes to ensure compliance with applicable federal, state, and local requirements.
Handles bill review process by researching and interpreting state fee schedules, laws, and regulations, and applying them to current processes or developing new procedures ; ensuring fee schedule changes are applied and communicated to vendor processors to ensure bill review compliance; testing and approving new or updating system applications; ensuring bill review software is functional to communicate software needs or programming issues to the bill review vendor; developing alternate workflows to accommodate system deficiencies; submitting rule requests to coordinators for testing to ensure rule accuracy; and using reports and logs to identify negative trends and creating action plans to mitigate disputes and penalties and to identify positive trends to maximize benefits.
Handles vendor processors and vendor payments by communicating expectations to vendors and ensuring vendors comply with contractual obligations; verifying vendor invoices; developing and reviewing reports to track vendor performance; providing guidance to vendors on policies and best practices and supporting vendors with bill decisions and guidelines; and participating in vendor selection and on boarding.
Assists in the creation and completion of legal documents for contract enrollment within predefined parameters by providing required information on contracts and documents; and communicating information to various contacts (for example, internal and external legal counsel, senior leadership, payer).
Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Bachelor’s degree in Business Administration, Computer Science, Finance, Accounting, or related field OR 2 years’ experience in accounting, medical billing, medical coding, or related area.
Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.