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Job Duties

  • Evaluates child/youth's case for compliance to applicable regulations.
    • Clearly communicates evaluation requirements and follow up.
    • Evaluate documentation against applicable regulations.
    • Collect and submit data and documentation to support compliance findings.
    • Records and summarizes compliance findings for the Children's Transformation Program.
    • Assists in determining trends in non-compliance.
    • Makes appropriate and timely recommendations to project management.
  • Assists with the ongoing operationalization of project's processes and procedures.
  • Builds and maintains relationships with stakeholders to provide a high level of customer service.
  • Coordinates as needed to schedule onsite visits and/or remote case review.
Required Qualifications
  • One year of experience with monitoring compliance or FFS Medicaid or Managed Care billing.
  • Proficiency in MS Excel, MS Word, MS Outlook, MS Visio, MS PowerPoint and MS SharePoint.
Preferred/Desired Qualifications
  • A minimum of 2 years' experience as a Registered Nurse in a role working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, persons with emotional disturbances, or persons with developmental disabilities.
  • Experience with multiple Electronic Health Record applications.
  • Ability to work with and relate to staff and demonstrate active listening skills.
  • Process oriented and results-driven work strategy.
  • Ability to foster teamwork with all levels of management and staff.
  • Ability to work well independently and within a team.
  • Exceptional Customer Service relationship techniques, including superior verbal and written communication skills.
  • Excellent accuracy and attention to detail.
  • Experience in meeting deadlines and adhering to strict standard.

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