What are the responsibilities and job description for the Medicaid Program Specialist position at Vertex Group?
Must be Local to OH (Hybrid)
- Experience with Medicaid and/or Medicare programs and reporting
- Superior communication, critical thinking, teamwork and project management skills
- Experience with Claim adjudication and provider reimbursements
- Writing SQL queries to extract data from the database, analysis of configuration data to identify clean-up activities.
- Ensure agreement configuration accuracy that may impact provider payment and member responsibility.
- Set up new Network and Agreement configurations into the Facets system.
- Validate agreement and network configuration utilizing claims testing, SQL queries and Excel to ensure the configuration properly adjudicates during claims processing, for member benefit, reimbursements and provider pay amounts.
- Perform and resolve network and agreement configuration questions/issues sent to the Business Configuration team without guidance.
- Maintain relationships with Account Managers, and Provider teams in order to develop a cohesive cross functional, results driven working environment.
- Self-manage completion of work inventory within established quality and turnaround time guidelines.
- Coordinate and participate in cross-functional team activities for issue resolution.
- Recommend process and system enhancements to drive improvements.
- Support the management team with on-going training activities, misc. projects, resolving issues, and serving as a subject matter expert for all Configuration requests.
Job Type: Contract
Pay: $30.00 - $40.00 per hour
Expected hours: 40 per week
Schedule:
- 8 hour shift
Experience:
- Claim adjudication: 2 years (Required)
Ability to Commute:
- Mason, OH 45040 (Required)
Work Location: In person
Salary : $30 - $40
