Medicaid Provider Consultant Jobs

3+ years of HCBS and/or behavioral health funding/finance/reimbursement experience

3+ years of experience analyzing health care administrative data

Working knowledge of Medicaid program rules and regulations for provider payments preferred

Managing data analysis and modeling using administrative claims data

Reviewing the analytical work of project teams and ensuring Milliman’s quality control processes and procedures are being followed

Drafting client reports and presentation materials

5+ years of experience designing payment systems and setting reimbursement rates for institutional health care providers

Working knowledge of Medicaid program rules and regulations for provider payments preferred, but not required

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

Prospective payment systems for inpatient and outpatient hospital services

Acuity-adjusted payment methodologies for nursing facilities

Supplemental payments, including state, directed payment arrangements, UPL payments, and disproportionate share hospital (DSH) payments

Advanced level, report, communicate, research laws at the advanced level, regulations, requirements, regulatory audits and/or exams.

At the advanced level, analyze and extract regulatory data, documentation for compliance with requirements.

Provide advanced level support to regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments.

Be part of an Extraordinary Team

Three (3) or more years of leadership experience leading a team of direct reports.

Proven interpersonal, organizational, written, and oral communication and presentation skills.

Experience operating in a matrixed environment and coordinating across various departments.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Understanding of learning design principles and proven application of those principles to create easy-to-read and captivating provider training and educational materials.

Experience with establishing a new team and/or new processes.

At least years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts

Experience with behavioral health contracting

Excellent written and verbal communication skills

Ability to manage multiple priorities in a fast-paced environment

Experience working with Medicaid contracts

This is a remote position; however, candidates must reside in the state of Indiana.

At least 1 year of provider relations, provider contracting, or account management experience

Excellent written and oral communication skills

Ability to manage multiple priorities in a fast-paced environment

Knowledge of Microsoft Office applications, specifically working with large amounts of data in Excel

This is a remote position; however, candidates must reside in the state of Indiana

Must reside in the state of Indiana

4+ years experience performing performance metrics measurements and reporting to management and executive level staff.

Address problems through risk management and contingency planning

Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools

Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES

5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative

Demonstrated experience working with SMC/OBC

Knowledge, Skills, And Abilities Requirements

Work with management to turn negative outcomes into positive outcomes

Knowledge/experience with Medicaid Lines of Business

Excellent written and verbal communication skills

Ability to manage time and identify opportunities to grow and excel as a team

Strong computer skills with an understanding of G Suite - Gmail, Drive, Calendar, Docs, Sheets