The Health Insurance Payments Assistant Manager supports the Medicaid and Children’s Health Insurance Program (CHIP) Payment Error Rate Measurement (PERM) review requirements established by the Centers for Medicare and Medicaid Services (CMS). This position assists with managing a team of Health Insurance Payment Analysts and is responsible for ensuring the team meets production standards and the findings of audits/reviews are accurate. The Health Insurance Payments Assistant Manager may travel throughout the United States to oversee on-site reviews up to 25% time.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include the following. Other duties may be assigned.
Responsible for the integration of CNI Core Competencies into daily functions, including: commitment to integrity, knowledge/quality of work, supporting financial goals of the company, initiative/motivation, cooperation/relationships, problem analysis/discretion, accomplishing goals through organization, positive oral/written communication skills, leadership abilities, commitment to Affirmative Action, reliability/dependability, flexibility, and ownership/accountability of actions taken.
Serves as a subject matter expert (SME) for the PERM Data Processing (DP) review team as needed.
Conducts DP state orientation, data and systems access intake meetings.
Works with the DP state leads and state personnel to determine readiness for initiation of PERM DP reviews.
Develops intake and preparation tools/checklists for on-site and remote reviews to ensure consistent preparation before cycle initiation.
Oversees and manages timely and accurate compilation and reporting of review completion issues due to both data inadequacies and system access limitations.
Monitors and analyzes claims placed in pending status to identify root causes, determine actionable items and proposes potential data, system access and/or process improvements designed to minimize the number of pending claims. Expedites timely review completions on a proactive basis.
Creates schedules for both onsite reviews and remote access reviews. Determines review team assignments along with Project Leadership.
Assists with development of review workflow processes and identifies SMERF enhancements, including participation in joint application design (JAD) sessions.
Assists in development of continuous improvement initiatives to better utilize available data. This includes Sample Unit Coordination (SUC) Data Analysis regarding information gaps, pended claims, error citations and other potential improvements.
Prepares and monitors DP reports. Collaborates, as needed, with the DP Review Manager and project leadership to develop strategies to achieve established DP contractual milestones, as well as, individual performance improvement among DP Review staff.
Identifies training needs and collaborates with the DP Training Manager, DP Manager, DP SME and Q/A Leaders to define and prioritize needs.
Performs multi-level DP reviews as business needs dictate.
Monitors staff performance, providing timely feedback, guidance, and corrective action as warranted.
Collaborates with the Regulation and Policy Manager to identify and incorporate regulation changes into DP review processes.
Assists DP state leads with issue resolution, serving as a point of escalation to facilitate resolution of difficult issues.
Provides onsite support and oversight as business needs dictate.
Actively participates in internal and external meetings, providing DP subject matter expertise and recommendations as needed.
Maintains the confidentiality of patient information in accordance with HIPAA regulations.
Responsible for aiding in own self-development by being available and receptive to all training made available by the company.
Plans daily activities within the guidelines of company policy, job description and supervisor’s instruction in such a way as to maximize personal output.
Responsible for keeping own immediate work area in a neat and orderly condition to ensure safety of self and co-workers. Will report any unsafe conditions and/or practices to the appropriate supervisor and human resources. Will immediately correct any unsafe conditions to the best of own ability.
Bachelor's degree and a minimum of ten (10) years relevant experience, or equivalent combination of education / experience. Work experience may be substituted at a rate of two years per one year of formal education. Experience working as a client-facing manager within a Medicaid or other health insurance claims environment is preferred. Experience developing junior staff and leading other personnel effectively is preferred. Demonstrated experience and technical expertise in Healthcare Audits, Claims Processing operations, and application of State and Federal regulations, policies and mandates.
CERTIFICATES, LICENSES, REGISTRATION
Must be able to obtain government security clearance
U.S. Citizens / Green Card only due to government or federal requirement
JOB SPECIFIC KNOWLEDGE / SKILLS / ABILITIES
Knowledge of Medicaid programs and Medicaid Management Information Systems (MMIS)
Skilled proficiency in the use of Microsoft Office Suite (i.e., Word, Excel, Outlook, Visio, Project, etc.), with proficiency in the use of Microsoft SharePoint
Excellent project management skills relative to all aspects of planning, organizing and coordinating assigned projects with stakeholders
Strong analytical skills with the ability to collect, organize, evaluate and disseminate significant amounts of information, producing results with minimal supervision
Must possess strong interpersonal and communication skills
Demonstrated time-management and organizational skills
Must have excellent follow through with attention to detail and accuracy
Ability to adapt communications depending on the audience, both technical and non-technical.
Ability to work well in both a team and independent environment
Ability to work with senior level internal and external stakeholders
Ability to collect and analyze complex data, both statistically and through the use of narrative
Experience working under pressure and in a fast-paced environment
Exceptional attention to detail, ability to multi-task and meet tight deadlines
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume. Ability to apply concepts of basic algebra and geometry.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.