Collection of data from the fiscal agent,performing analysis, creating and maintaining spreadsheets of information to be used for program performance evaluation. Provides assistance to Bureau of Medical Services (BMS) staff, affiliated agencies i.e., DHHR fraud unit, state legislative auditors, children with special care needs, RESA, and other statewide programs. Provides assistance in document research as required by auditors, providers, and other agencies as needed. Assures compliance with state and federal laws and regulations governing the program contract operations and technical areas. Responsible for reviewing the FA's operational procedures and policies related to their technical function . requires good verbal and writing communication skills to relay monitoring activity results to supervisor Molina staff. Recommend and establish new monitoring processes, based on research. Responsible for monitoring sterilization and hysterectomy prior authorizations issued by Molina medical staff verifying contractual compliance. This includes creating spreadsheet of data from molina operations data, production reports, and research. Works with the medicareand tpl units to assure correct coding and keying from explanation of benefits. Works with pharmacy unit regarding processing of claims and reports. may act as a back-up to supervisor. May assign and review work of clerical staff. Other duties as assigned. Medicaid experience and/or ability to quickly learn medicaid procedures.
Hiring Process: APPLY ONLINE. Do not use a paper application unless you cannot apply online. If you must use a paper application due to disability or other valid reason, please call our office (304) 558-3950 ext. 57207 for special instructions. Your eligible score will be based on information provided in your application.
If you have previously applied and want to update your name, address or email, do not re-apply. Simply login to your online account and click "My Account" . Make changes and Save. If you must change or add work preferences, county availability, work history, or education, you may submit a revised application after 24 hours. We will use the most recent application. You MUST do this BEFORE the closing date. After that, you may send us a letter and we will update your record.
IMPORTANT: This posting is for one or more specific vacancies. Applicants will be considered ONLY for these position(s) and specified location(s). Your application will remain active for this job for 120 days or until the job is filled. Should this job title be re-opened for applications at a later date, applicants who remain interested in this job title MUST re-apply to be considered. You may complete an online Interest Card at our main jobs page to receive an email notice anytime jobs in this or other categories are posted.
Training: Graduation from an accredited four-year college or university.
Substitution: Full-time or equivalent part-time paid experience in paraprofessional or responsible clerical work at a level consistent with the work performed by an Office Assistant III and which required application of state and federal laws and/or guidelines, may be substituted for the required training on a year-for-year basis.
NOTE: You may attach your transcript or training records to the online application; however, verification is not required at time of application. Your application MUST contain complete education/training information. You will be required to provide verification documents if contacted by the agency. Important: If you have a Regents Bachelor or Arts (RBA) degree you should attached or send a transcript as soon as possible after applying so that we may properly review any required specialty course work.
If you decide to apply you will be required to answer the online Supplemental Questions shown in the tab above.
State of West Virginia - 5 months ago