Departmental Specialist 13 - HS ENROLLMENT AND PAYMENT INTEGRITY SECTION
Tasks
- Analyze Medicaid Data Warehouse information
- Assess payment adjudication outcomes
- Conduct EVV adoption compliance monitoring
- Flag non compliant activity
- Identify program integrity misalignments
- Initiate corrective actions
- Interpret federal and state regulations
- Monitor state directed payments compliance
- Perform policy research
- Provide compliance guidance for operational decisions
- Review EAE compliance requirements
- Review claims and encounter reporting
Perks/Benefits
Skills/Tech-stack
Claims Processing | Compliance Monitoring | Data Analysis | Electronic Visit Verification | Managed care | Medicaid | Medicaid managed care | Medicare Advantage | Medicare D SNP | Payment Adjudication | Regulatory Compliance
Education
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