Minimum Qualifications
Bachelor's Degree
Minimum of five (5) years of healthcare industry experience, preferably with a health plan or a pharmacy
A working knowledge of healthcare operations to include: enrollment, claims, customer service and appeals
Demonstrated project management experience
Applied analytical skills
Strong written and verbal communication skills
Proficiency in Microsoft Office Suite, including Access, Excel, Power Point and Word
Proven ability to lead a team and successfully complete both short and long-term assignments
Ability to lead executive level meetings and/or presentations
Demonstrated strategic planning skills
A working knowledge of Medicaid/Medical Assistance
Role Description
Manage both direct and indirect reports to accomplish tactical and longer term departmental projects (program management office)
Maintain project documentation and work plans
Analyze internal processes to identify efficiencies and to reduce operating costs
Develop comprehensive training for both new hires and existing staff
Create executive level reports and oral presentations
Provide cost benefit analyses for new initiatives
Assist with budget analysis, tracking and updates
Monitor departmental performance measures
Resolve cross-departmental issues as assigned
Resolve complex customer issues
Participate in project meetings
Assist with data collection for industry surveys and reports
Attend industry meetings as requested
Provide recommendations for the strategic development of the program
Identify and assist with the implementation of cost containment initiatives
Assist with procurement documents, including Requests for Proposals, contracts and contract amendments
Identify potential areas of fraud, waste or abuse in the Medical Assistance program and remedies to address them.
Provide updates on, and impact analysis of, federal and state statutes, regulations, policies and procedures governing the MA program
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