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Medicaid Liability Leader - Remote

Remote:

Full Remote

Contract:

Full time

Salary:

86 - 165K yearly

Experience:

Mid-level (2-5 years)

Work from:

New York (USA), United States

Offer summary

Qualifications:

Bachelor’s degree in healthcare, business administration, law, or related field; Master’s preferred, 10-12+ years’ experience in compliance-related matters in the health care industry, 3+ years’ experience with NYS Medicaid, process management experience, understanding of healthcare liability potential, Extensive experience with federal and state regulatory guidance, Excellent communication skills and proficiency with MS Office.

Key responsabilities:

Oversee cross functional activity related to Medicaid audits
Lead collaboration efforts with various departments for audit requirements
Manage project tasks and address auditor findings before deadlines
Provide analysis, recommendations, and reports to senior management
Review and manage liabilities by recommending mitigation strategies

EmblemHealth Insurance Large https://www.emblemhealth.com/

1001 - 5000 Employees

See more EmblemHealth offers

Job description

Your missions

Summary Of Job

Responsible for the oversight of cross functional activity related to Medicaid audits conducted by OMIG, AIG and their agents for Medicaid, Child Health Plus, HARP and other State Sponsored (“Medicaid”) lines of business. Responsible for ensuring that EmblemHealth and its delegates comply with encounter data submissions & reconciliation as well as retroactive enrollment audits for Medicaid, Child Health Plus, HARP and other State Sponsored (“Medicaid”) lines of business. Lead collaboration efforts with Enrollment, Compliance, Finance, Actuarial, Legal, Claims, and Pharmacy to ensure accurate and comprehensive delivery of audit requirements.

Responsibilities

Lead cross‐functional activity related to Medicaid Audits conducted by DOH, OMIG, HMS and AG for audit types: Third Party Health Insurance; EmblemHealth and external Plans, Retroactive disenrollment (Incarcerated, deceased), Supplemental Maternity capitation, Family Planning, Nursing home placement, Foster Care, and Multiple Client Identification Number.
Manage the tasks and projects exclusive of the OMIG audits themselves (handled by External Regulatory Audit (in Compliance function).
Track findings identified by the auditors; ensure that all issues are addressed in full before the required deadline.
Evaluate the impact of each finding, stratify findings in terms of impact on EmblemHealth, and provide appropriate recommendations to address each finding as needed, based on operational best practices and sound judgment.
Provide analysis and recommendations to strengthen operations to limit current & future liability.
Interface with external resources (Trade Associations (HPA/Manatt), outside counsel, OMIG, DOH).
Partner with finance and business owners to ensure appropriate reserving for future audits during monthly financial close.
Lead the collection, retention, and submission of encounter reimbursement offsets.
Perform data analysis, cross referencing, etc., to facilitate accurate dispute analysis
Partner with External Regulatory Audit function to manage incoming Medicaid regulatory communications, review & approve narrative responses to auditors.
Lead cross collaboration with all operational departments impacted by audit activities to implement best practices.
Produce and present reports to the Assistant Vice President on a regular basis on the status of all projects.
Maintain a working knowledge of relevant issues, laws, regulations, and industry best‐practices to ensure operational.

areas across the Medicaid lines of business are compliant.

Review/manage BHET/MMCOR liabilities by recommending and implementing mitigation strategies for prior time periods and for current/future time periods.

Qualifications

Bachelor’s degree in healthcare, business administration, law, or related field; Master’s Preferred
10 – 12+ years’ experience in compliance‐related matters, preferably in the health care industry (Required)
3+ years’ experience with NYS Medicaid covering OMIG, MMCOR, or EIS/APD (SP)
Staff and process management experience (Required)
Understanding of the healthcare environment as it relates to liability potential (Required)
Extensive experience with federal and/or state regulatory guidance (Required)
Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
Proficiency with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) (Required)

Additional Information

Requisition ID: 1000001927
Hiring Range: $86,000-$165,000

Required profile

Experience

Level of experience: Mid-level (2-5 years)

Industry :

Insurance

Spoken language(s):

Check out the description to know which languages are mandatory.

Hard Skills

Soft Skills

verbal-communication-skills
Organizational Skills
Teamwork
Leadership

Are you interested?

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