Public Consulting Group

Provider Management Specialist

Job Locations US-OH | US
Posted Date 5 months ago(1/26/2022 8:49 AM)
Job ID
2022-7639
# of Openings
3
Category
Clinical Review
Type
Regular Full-Time
Practice Area
Health Services

Overview

Provider Management Specialist in Ohio

 

Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

Responsibilities

Duties & Responsibilities:

  • Evaluates provider documentation and billing to ensure compliance with waiver program rules and regulations
  • Educates Medicaid providers of all applicable rules, responsibilities, and best practices related to providing services to Medicaid recipients
  • Meets with providers to collect data and documentation from providers to support compliance findings
  • Uses technology and web-based applications to conduct and monitor all work within specified timelines according to quality standards
  • Writes accurate and detailed reports on all findings for providers and Medicaid
  • Reviews provider Plans of Corrections to ensure they are in compliance with all applicable rules and regulations
  • Makes referrals to law enforcement, county children's services, adult protective units, county board of developmental disabilities, or any other entity as needed
  • Gathers information to write and submit referrals to Ohio Department of Medicaid for egregious provider behavior
  • Maintains HIPAA and confidentiality
  • Completes all other duties as needed and assigned

Required Skills:

  • Ability to think critically, incorporating multiple factors into larger concepts
  • Strong organizational skills with abilities to simultaneously manage multiple responsibilities
  • Ability to work with and relate to others with customer relation techniques, professionalism and with respect for other cultures
  • Ability to effectively use active listening and interviewing skills
  • Must be computer literate and proficient with MS Word, Excel, and Outlook
  • Ability to foster teamwork with all levels of management and staff
  • Ability to work well independently, both remotely and within a team
  • Superior verbal and written communication skills
  • Proficiency with basic math skills
  • Strong and independent decision-making skills, with accuracy and attention to detail
  • Demonstrates excellent time management, initiative, self-direction, and accountability

Qualifications

Basic Qualifications:

  • Bachelor’s degree in any field preferred, or the equivalent of 36 months of experience in any field and a minimum of two years paid experience working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, or persons with developmental disabilities.
  • One year of that experience must have included provider monitoring, Medicaid or third-party payer provider billing, or provider training. One year of that experiences must have been in a home health program, community health program, hospital, private practice, publicly funded institution, long-term care program, mental health program, community-based social services program, or any other program addressing the needs of special populations.

WORKING CONDITIONS:

  • Office Setting - may work in central office or home office.
  • Travel requirements: -Must possess a valid Driver's license.
  • Use of personal vehicle required.
  • ~35-40% local travel, as needed.

 

*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.

 

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

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