Medicaid Reimbursement Specialist

The incumbent will: facilitate State Operations and Technical Assistance (SOTA) calls with Centers for Medicare and Medicaid Services (CMS), project plans for updating and for emerging policy initiatives as well as addressing marketplace challenges, assume the leading role in the division's work on the CMS mandated Statewide Transition Plan, direct the Community First Choice Option (CFCO) Development and Implementation, research and utilize relevant data to update policies, write briefs and reports for upper management and supervise a staff of six.

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

• Evaluates financial requirements and the impact of policies and legislation on the Medicaid program provider and contractor activities. Interprets reimbursement policies to ensure compliance with federal regulatory requirements. Recommends and develops reimbursement procedures to meet new or existing legislative requirements or to improve overall program efficiency.
   
• Examines existing State agency and intermediary cost and reimbursement systems, identifies problem areas and recommends modifications to correct system deficiencies.
   
• Performs short and long-range studies concerned with the development, application, and appraisal of reimbursement for services provided by hospitals, long-term facilities, home health agencies, and all other program providers.
   
• Provides assistance to providers and contractors regarding provider reimbursement, financial review problems, and Medicaid recoveries.  Reviews cost reports submitted by providers and oversees corrective action.  Obtains and analyzes information on reimbursement and recovery systems and evaluates the applicability and impact of any changes to the Medicaid program.
   
• Participates in the review and recommends approval/disapproval of Medicaid State Plan segments pertaining to provider reimbursement.
   
• Evaluates overpayment recovery procedures and initiates effective recovery efforts. Evaluates contractor documentation of audits and development of overpayment as appropriate.
   
• Provides technical and factual case information to Department of Justice, Health and Social Services, and HCFA as required.
   
• Supervises the work of subordinate staff.
   
• Prepares clear, complete, and concise records, reports, summaries, analysis, evaluations, and recommendations; Develops and evaluates statistical data.

JOB REQUIREMENTS for Medicaid Reimbursement Specialist
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

1. Three years experience in health care reimbursement which includes reviewing and categorizing claims for proper billing, analyzing cost reports, examining cost containment, and interpreting and analyzing laws, rules, regulations, policies, procedures and standards affecting reimbursement and recovery.
2. Three years experience in compiling, analyzing and interpreting financial data to ensure effective and efficient accounting of funds or to make projections for financial planning.
3. Six months experience in inferential statistics such as correlation, t-tests, f-tests or analysis of variance.
4. Six months experience in narrative report writing.
5. Knowledge of staff supervision of two or more employees which includes to plan, assign, review, discipline, recommend hire, promotion, termination and administer performance plans and reviews. 

To learn more about the comprehensive benefit package please visit our website at http://ben.omb.delaware.gov/

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at www.delawarestatejobs.com.

Accommodations are available for applicants with disabilities in all phases of the application and employment process.  To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance.  The State of Delaware – An Equal Opportunity and Affirmative Action Employer.