Medicaid Utilization Review Analyst

Description

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

People Making a Difference!

***THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.

Medicaid Utilization Review Analysts are instrumental in protecting the integrity of the Medicaid program. The individual will conduct preliminary investigations, audit Medicaid billings, and represent the Department as an excellent communicator with providers, in presentations, in hearings, with agencies, and with community businesses. A positive and professional image, excellent research and analytical skills, and decisiveness with the ability to communicate well are critical for this position.

The successful candidate will be required to pass a background investigation and an expanded reference check.

BENEFITS:

BEST RETIREMENT AVAILABLE IN THE NATION

We have one of the Nation's best state retirement systems (PERSI) that offers a lifetime benefit.

OTHER EXCELLENT BENEFITS

• Basic life insurance for employee and family (employee covered at one times annual salary; spouse covered at $10,000; child covered at $5,000)
• Ongoing training opportunities
• Multiple savings plans, optional 401K, and optional 457
• Paid parental leave
• Wellness programs
• 11 paid holidays a year
• And more!
• An opportunity for student loan forgiveness
• Generous vacation and sick leave accrual beginning as soon as you start
• Excellent medical, dental and vision insurance- (full-time) employee only coverage for PPO $65/month for medical and vision & $11.00/month for dental

EXAMPLE OF DUTIES:

• Recommends and participates in development and implementation of policies and procedures for monitoring program utilization.
• Meets with providers to discuss findings.
• Confers with professional medical consultants concerning appropriateness and quality of medical goods and services provided to clients.
• Makes and assists with presentations to internal units, provider groups, and Medicaid staff on Utilization Review policy and procedures.
• Develops cases by interviewing providers and clients, conducts on-site reviews, and documents evidence.
• Reviews and analyzes Medicaid Management Information System (MMIS) reports to identify utilization patterns and individual providers or clients who may be abusing the program.

MINIMUM QUALIFICATIONS:

You must possess all the minimum qualifications below to pass the exam for this position. Please make sure your resume or work history supports your meeting the minimum qualifications for this position. Failure to do this may disqualify you from being considered for this position.

Good knowledge of:

• Data processing systems as used in program monitoring and management information processes. Typically requires completion of coursework/training regarding data processing systems and their use OR at least six months of work experience working with the above type data processing systems.
• Medical terminology.
• Medical diagnostic and procedural terms.
• Common medical payment procedural codes used in Current Procedural Terminology Fourth Edition (CPT-4), and other nationally recognized coding references.

1-3 above typically requires completion of college level courses covering those items or a seminar or training for CPT-4/ICD OR at least one year of work experience using the above resources.

Experience:

• Recognizing patterns of medical assistance billing that suggest fraud, abuse, over-utilization, child abuse, and claims processing problems. Typically requires at least six months of work experience in a medical or insurance office with responsibility for reviewing or processing claims that included recognizing problems such as: patterns of abuse; fraud; incomplete information; improper coding, etc.
• Conducting interviews to obtain facts for cases. Typically requires at least six months of work experience conducting interviews for investigations to solicit facts, record information, and determine eligibility or an appropriate course of action based on findings. Types of qualifying experience could include a background in credit collection, law enforcement, financial institutions, or social service programs or services. Experience as an office/administrative support staff conducting informal day-to-day interviews is not in-depth enough to qualify. Experience conducting employment interviews is typically non-qualifying. Experience being interviewed, e.g. to obtain employment, does not qualify.
• Compiling, analyzing, and interpreting statistical data, and developing recommendations. Typically requires successful completion of coursework and/or training covering statistics AND at least six months of work experience that required both verbal and written communications of findings to both internal and external entities OR at least one year of work experience that required both verbal and written communications of findings to both internal and external entities.
• Providing verbal and written communication of findings to both internal and external entities. Typically requires successful completion of coursework and/or training covering statistics AND at least six months of work experience that required both verbal and written communications of findings to both internal and external entities OR at least one year of work experience that required both verbal and written communications of findings to both internal and external entities.

Learn About a Career with DHW

***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 11:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:

Email is the quickest way to get an answer to your questions.

(answered Monday through Friday during business hours MST)

EMAIL:

[email protected]

PHONE:

(208) 334-0681

EEO/ADA/Veteran:

The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email [email protected].

Preference may be given to veterans who qualify under state and federal laws and regulations.