Medicaid Healthcare Analytical And Problem Solving Skills Expert (Jobs in Lincoln   Requirement id 139290 Job title Expert Job location in Lincoln, NE Skills required Medicaid, Healthcare, MS Word, Analytical And Problem Solving Skills Open Date 24-Feb-2023 Close Date Job type Contract Duration 24 Months Compensation DOE Status requirement --- Job interview type ---    Email Recruiter: coolsoft Job Description Expert: Medicaid, Healthcare, MS Word, Analytical And Problem Solving Skills start date:3/20/2023 End date:03/31/2025 submission deadline:03/03/2023 client info : NeDHHS Note: Job Title: Medicaid Encounter Claim Processing and Reporting Subject Matter Expert (SME) * Position Location: Remote Description: Medicaid Encounter Claim Processing and Reporting Subject Matter Expert (SME) This position directly supports the State of Nebraskas Medicaid program. Key job activities will be providing expertise and recommendations on strategies for monitoring and continually improving Medicaid encounter data. This position provides flexible part time work hours and is a fully remote position. Job Responsibilities: Serve as the subject matter expert in Medicaid encounter claim processing and reporting. Provide expert level encounter transaction knowledge that includes HIPAA x12 837 and NCPDP claim requirements, as well as the end-to-end processes. (from the managed care plan(s) healthcare claim processing systems to the states data warehouse, CMS T-MSIS reporting files and other downstream reports) Advise program stakeholders in maintaining business rules edits for encounter claims. Work with stakeholders at every level of the organization to prepare recommendations and detailed plans for improving encounter data and ensuring compliance with federal and state regulations. Provide support for the identification and resolution of the root cause for systemic encounter error trends. Provide support to operational and technical teams for auditing or inquiries. Actively engage with health plans and internal business/technical teams to ensure consistency and improvement of encounter data quality. Create technical guidance documents for improvement of encounter data quality. Support technical and data teams on the achievement of target T-MSIS data quality and completeness. Translate technical and complex encounter concepts in ways that can be understood by a variety of audiences, including senior leaders and external stakeholders. Understand state Medicaid policies/processes to carry out research and analysis, support writing business requirements documents, preparing test cases and testing out the enhancements in various testing environments to mitigate adverse effects. Work with the state and state partners to identify opportunities to implement new standard methods and improve current methods of reporting of non-standard claims medical payments, such as sub capitated, alternative payments, encounters, and value based payments through encounters submission processes. Help business and leadership team with problem definition. Required Credentials and Experience: 7+ years direct experience with Medicaid fee for service and managed care encounter claim processing. In-depth knowledge and technical understanding of the various segments of healthcare X12 837P/I/D EDI formats. Expert knowledge of healthcare industry claim coding standards. Microsoft Word (creating, editing, and saving documents), Microsoft Outlook (email and calendar management), Microsoft PowerPoint (creating, editing and presenting slide decks) and Microsoft Excel (filtering, sorting and editing data in spreadsheets, formulas, and creating pivot tables). Analysis and problem-solving skills to resolve operational problems and improve reporting performance. Quantitative data analysis skills for analyzing claims and encounter data. Ability to summarize technical claim and complex clinical information and explain it to less-technical team members. Strong communication skills in e-mail, over the phone and in person are required. Transformed Medicaid Statistical Information System (T-MSIS) Analytic fil   Call 502-379-4456 Ext 100 for more details. Please provide Requirement id: 139290 while calling.   Other jobs in NE: Lincoln (21), Medicaid job openings in Lincoln, NE Jobs List IT Business Systems Analyst - Senior - 45992 Create date: 16-May-2014 Description: * Organize, drive and facilitate project teams in gathering, definition and documentation of highly complex business requirements using the critical components of best practice BA methodologies and the institutional SLDC and methods. 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