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Program Specialist - Data Claims Management (3464)

Program Support | Harrisburg, PA | Contract

Job Description

Program Specialist - Data Claims Management
Work Location: Harrisburg, PA


Job Summary/Description

The Program Specialist will assist with the development, maintenance, and evaluation of data systems and procedures designed to support managed care programs (i.e. HealthChoices and Community HealthChoices) administered by the office. This may include working with managed care organizations (MCOs) for the submission of encounter data, monitoring of the systems portion of the contracts with the MCOs, monitoring of capitation and maternity care payments made to MCOs, and verifying managed care eligibility. If you meet the qualifications and skill set, please apply and a recruiter will reach out to you and answer any questions you may have.


Job Duties/Responsibilities/Functions(including but not limited to)

• Reviews 837 and NCPDP encounter file submissions to assist MCOs in passing edits and audits within the Department’s MMIS (PROMISe).

• Performs retrospective data reviews to ensure data quality of system contract requirements have been achieved.

• Monitors and validates accuracy of payments made to MCOs, as well as MCO excluded services.

• Responds to inquiries relating to encounter submissions, systems contract monitoring requirements submitted through public email boxes.

• Reviews, analyzes, and recommends revisions to existing and proposed policies, regulations, and procedures.

• Performs other duties as assigned and requested.


Minimum Qualifications

• Bachelor’s Degree or equivalent experience

• Require at least two (2) years of healthcare industry experience, preferably with a health plan

• Require a working knowledge of healthcare operations preferably: customer service, claims/capitation processing, HIPAA 837 and NCPDP transaction sets, encounter submissions, contract monitoring, or enrollment

• Require HealthCare Claims processing and/or medical coding experience

• Require applied analytical skills

• Require Strong written and verbal communication skills

• Require proficiency in Microsoft Office Suite, including Access, Excel, PowerPoint and Word

• Require proven ability to successfully complete both short and long-term assignments

• Require ability to lead meetings and/or presentations

• Demonstrated problem solving skills, strong conceptual and analytical skills, including the ability to analyze and interpret data and trends

• Demonstrated teambuilding skills, proven ability to interact at all levels of the organization and a demonstrated record of success in managing personnel from multiple disciplines

• Ability to analyze policies and contracts and apply to compliance requirements

• Excellent organizational and strategic planning skills

• Ability to think and work independently

• A working knowledge of Medicaid/Medical Assistance


About InGenesis

InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.


EEOC Statement

We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.