Niles Executive Recruitment Jobs

Medicaid Manager Posted Nov 20
Confidential, Cincinnati, OH
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Job Title: Medicaid Manager
Relocation Available: No
Location: Cincinnati, Ohio
Job Type: Permanent full-time

Job description:
Position Summary: Primarily responsible leadership and management of the Medicaid Department.

General Purpose: Leadership; problem resolution; critical thinking; auditing; relationship and team building; process development and improvement

Essential Duties and Responsibilities:
• Work with Human Resources staff to recruit, interview, select and hire for the Medicaid Department.
• Coach, mentor and develop staff, including overseeing new employee onboarding and providing development and education opportunities for the Medicaid Department.
• Lead employees to meet the organization's expectations for productivity, quality, and goal achievement.
• Plan and allocate resources to appropriately staff each assignment.
• Evaluate and improve departmental operating procedures to enhance speed, quality, efficiency and financial results.
• Review performance data to monitor and measure departmental productivity, goal achievement, and overall effectiveness.
• Review insurance contracts and Medicaid Provider Manuals to gain thorough understanding of payment methodologies.
• Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports, electronic tools and supporting documentation.
• Contact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of client.
• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting.
• Maintain regular contact with necessary parties regarding project status including payors, clients, managers, and other company personnel.
• Build strong, lasting relationships with clients, payors and company personnel.
• Organize, prepare and/or attend department, client and company meetings.
• Comply with federal and state laws, company policies and procedures.

Essential Skills and Experience:
• Minimum 5-years Management experience
• Minimum 2-years Healthcare related experience
• Excellent interpersonal skills with proven ability to motivate and lead a team