Job Description

HBITS-04-12835

Specific responsibilities and duties will include:

• Monitors and troubleshoot nightly Eligibility and Managed Care Enrollment 834\'s reports from NYSoH
• Data Correction - Analyze, Review and Assists NYSoH/eMedNY with Data Corrections
• Single-Source- working with single source team as 834 Expert. Assisting team to implement single source of enrollment process
• Review 834 X12 processing logic /rules --> Analyze and identify the gap
• Reconciliation (Baseline reconciliation/EP/Medicaid and CHP) - Analysis of the Data Match produced by NYSoH and eMedNY and Issuers
• Writing PL/Sql queries/Procedure to extract data
• Managing and executing EP/CR\'s projects
• Review and fix eMedNY Client\'s coverage
• Analyzing FIDA reports from Maximus
• Review daily report for Essential Plan/CHP/Medicaid and their issues

Project Manager
Plans, organizes and integrates cross-functional information technology projects that are significant in scope and impact.

Senior 60 - 84 months: Candidate is able to work independently, without assistance and provides guidance to others. May have an advanced education. * Bachelor\'s degree.

• 60 months experience with the Title XIX Medicaid Program.
• 60 months experience with claims payment systems such as eMedNY, with special emphasis on interfaces with other systems
• 48 months experience with TPL in a Medicaid environment and the interactions between Medicaid, Medicare and commercial insurance providers, with special emphasis on systems integration
• 36 months experience with local district Medicaid operations and TPL procedures.
• 36 months experience supervising staff.
• 24 months experience with developing and maintaining working relationships with local districts, and/or the Medicaid provider community, other bureaus within state and federal agencies.

MVP Consulting