Medicaid Policy & Regulation Analyst Position
责任安全保护服务 (SGS),是佩拉顿的子公司，执行数据分析，调查和医疗审查以检测，预防，阻止，减少和提交传递来恢复欺诈，浪费和滥用。你会做什么：该职位是在 SGS NE UPIC 合同中支持东北部司法管辖区内的医疗补助计划。东北司法管辖范围包括以下州：缅因州，佛蒙特州，新罕布什尔州，马萨诸塞州，罗德岛，康涅狄格州，纽约州，新泽西州，宾夕法尼亚州，德华纳州，马里兰州以及哥伦比亚特区。作为主题专家，该职位将努力了解这些计划及其各自细微差异。并与更大的医疗补助团队合作，主要研究和教育，同时开发项目或回应推。额外责任：· 用书面方式以及通过讨论/演示来阐述政策/规则。· 提供一份关于分析结果报告的书面政策贡献。· 与项目协调团队和数据团队合作，咨询确定项目。· 识别出来自政策研究的潜在方案漏洞。· 与司法管辖区的国家进行沟通，参与政策讨论。·与 CMS 进行沟通以参与政策讨论；· 保持最新的新兴问题和发展，直接影响该地区国家医疗补助计划。· 根据要求协助医疗补救行动领导人开展特殊研究项目。· 拥有医疗补助政策和程序手册，包括年度审查以确定方向是否当前，可能包括必要的更新以及随着方向变化的临时更新 （即内部或由客户进行）. · 追踪政策工作负载并每月向医疗补救行动负责人报告。· 在与商业分析师协调下监督州会议议程和分钟过程。· 职位将从所有州和时区可远程工作。
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Responsibilities
SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.
What you'll do:
This position is on the SGS NE UPIC contract supporting Medicaid initiatives across the northeastern jurisdiction. The northeastern jurisdiction includes the following states:
Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, and the District of Columbia.
This individual’s primary responsibilities are to research, understand, and articulate Federal and State regulations and policy as they relate to the administration of the State Medicaid programs for those states within the northeastern jurisdiction. As the subject matter expert, the position will work to gain an understanding of these programs and their respective nuances by state and work with the greater Medicaid team to primarily research and educate in tandem with project development or in response to referrals.
Additional Responsibilities:
- Articulate policy/regulations in both a written manner and through discussion/presentation.
- Provide a written policy contribution for incorporation into the Analytical Findings Report.
- Consult to identify projects in collaboration with the Project Coordination team and the Data team.
- Identify potential program vulnerabilities arising out of policy research.
- Interact with the states in the jurisdiction to engage in policy discussion.
- Interact with CMS to engage in policy discussion.
- Keep abreast of emerging issues and developments that have direct impact on the state Medicaid programs within the jurisdiction.
- Assist the Medicaid Operations Lead with special research projects as requested.
- Ownership of the Medicaid Policies & Procedures Manual to include an annual review to determine if direction is current, which may include needed updates as well as ad hoc updates as direction changes (i.e., internally or by the customer).
- Track policy workload and report monthly to the Medicaid Operations Lead.
- Oversee state meeting agendas and minutes process in coordination with the Business Analyst.
- Position will be Telework available from all states and time zone(s).
Qualifications
Basic Qualifications
- 5 years with BS/BA or 9 years with a HS Diploma
- At least 5 years’ experience in policy research and analysis.
- Ability to present and discuss state policies and regulations in connection with project impact.
- Ability to research policies, interpret regulations and regulatory rules/guidance.
- Strong interpersonal skills: ability to work and make decisions independently and in a team environment.
- Excellent planning, organizational skills.
- Excellent oral and written communications; able to communicate and make presentation to all levels of management and associates at all levels throughout the Company.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
- Ability to adapt to changing priorities, self-motivated and energetic qualities desirable.
- Experience using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook).
- US citizenship required
The most competitive candidates will have:
- Experience with CMS programs – Medicaid and Medicare.
- Experience with Managed Care programs.
- Knowledge of CMS regulations related to State Medicaid programs to include waivers.
- Knowledge of CMS 64 – analyse and interpret reports to determine trends and vulnerabilities.
- Knowledge of Federal Matched Assistance Program to State Medicaid programs.
- Medical Coding knowledge/experience related to billing of Medicare/Medicaid claims a plus.
Peraton Overview
Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.
Target Salary Range
$66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.EEO
EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.Originally posted on Himalayas