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World Relief · 12 hours ago

NC Medicaid Consultant

Durham, NC

Full-time

Onsite

Senior Level

World Relief is a global Christian humanitarian organization dedicated to addressing urgent humanitarian needs. They are seeking a Lead Consultant to assist in the effective implementation and growth of NC Medicaid managed care services, focusing on assessment and strategic planning in collaboration with key stakeholders.

CharityConsultingSocial

Growth Opportunities

Responsibilities

Conduct an in-depth assessment to strengthen World Relief's capacity and program quality

Collaborate with stakeholders to define specific goals and priority areas, assess the organization's viability for Medicaid managed care integration, and draft a detailed timeline and phased implementation plan

Identify and collaborate with key stakeholders (e.g. NC Medicaid, Alliance Health)

Draft a strategic plan tailored to the specific needs of the organization, outlining goals, priority areas, and a phased implementation timeline

Conduct a thorough review of contracts, job descriptions, policies, procedures, workflow processes, communication structures, IT systems, reporting mechanisms, program management, billing procedures, and specialty services

Provide holistic training for staff in critical areas such as workflow assessment, communication, IT systems, reporting, program management, and billing to ensure compliance and best practices

Lead the collaboration with stakeholders to identify goals and priority areas

Conduct analysis to assess World Relief’s current capacity and benchmarks to meet

Develop a detailed timeline and phased implementation plan

Craft a project schedule that outlines tasks, dependencies, and milestones to ensure a structured approach to the implementation process

Provide comprehensive oversight from inception to conclusion

Develop a detailed project plan delineating tasks, timelines, and resource allocation

Support the review of contracts, job descriptions, policies, and procedures

Collect and analyze data

Qualification

Medicaid ExpertiseData AnalysisElectronic Health RecordsHIPAA ComplianceHealth Care Billing

Required

Medicaid Expertise: Deep knowledge of NC Medicaid managed care, including eligibility criteria, billing codes, and reimbursement rates specific to mental health services for refugees and immigrants (specifically, interactive complexity and other related dynamics)

Preferred

Data Analysis and Reporting: Skills in collecting, analyzing, and reporting data to track program outcomes and meet NC Medicaid reporting requirements

Familiarity with Electronic Health Records systems. Although we have already selected Ritten as our EHR, the consultant should be proficient with and able to advise on how it can best integrate with workflows, billing, reporting, and data management

HIPAA and HITECH expertise to ensure that what is being set up is fully compliant

Health Care Billing including 835 and 837 EDI files. The consultant should help establish efficient billing processes for NC Medicaid mental health services. They should guide in implementing and managing 837 electronic claim submissions and 835 electronic remittance files. The consultant should help develop procedures for 'scrubbing' claims before submission to ensure accuracy and reduce claim denials. They should also assist in developing a system for managing claim denials and appeals