Job Details

Job Title

Job Summary: Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.

Knowledge/Skills/Abilities:

• Performs government contracts activities including maintenance of state correspondence and regulatory databases, communication of deliverables/submission between staff and governmental agencies, policy and procedure maintenance and review, and contract review.
• Maintains calendar and databases documenting regulatory filings, approvals of member materials, member/provider inquires and ad hoc regulatory requests.
• Responds to inquiries from government agencies regarding plan issues and requirements. Coordinates with other departments in resolution process. Maintains log to ensure prompt and timely resolution.
• Conducts research on government program and state requirements as needed.
• Helps maintain Government Contracts SharePoint site to store regulatory correspondence/reports/materials and ensure accessibility of information to staff.
• Participates in review of contract and regulatory requirements.
• Coordinates the maintenance, review, and dissemination of company policies and procedures.
• Assists in development and deployment of training programs related to government contract requirements.

Job Qualifications:

Required Education: High School diploma or equivalent

Required Experience:

• 2+ years experience in a managed care environment, preferably in Medicaid environment.
• Knowledge of state Medicaid Policies and Programs.

Required License, Certification, Association: N/A

Preferred Education: Bachelor's Degree in Business Administration, Healthcare or related field.

Preferred Experience:

• 2+ years compliance related experience.
• 1+ years in Medicare.

Preferred License, Certification, Association: N/A