Medicaid Certification Analyst Job at NTT DATA (Springfield)

New

Support Board Certified Behavior Analyst (BCBA) - 100% Remote

Oversee/supervise applied behavior therapy to families and individuals. Provides...

Location

United States , Omaha

Salary:

Not provided

Behaven Kids

Expiration Date

Until further notice

Requirements

Previous experience in working with children diagnosed with autism
Develop functional behavior assessments
Excellent verbal and written communication skills
Ability to challenge oneself to continue learning and growing as part of a multidisciplinary and motivated team
Ability to “think outside the box” to achieve positive outcomes for clients and team members
Ability to work during afternoon hours Central Time
Must be legally eligible for Nebraska behavior analyst licensure, including U.S. citizenship or lawful presence and ability to meet state licensing criteria
Certified BCBA in good standing with the BACB (Required)
2-4 years of related/relevant professional experience
Master’s Degree (Preferred)

Job Responsibility

Provide clinical support to the Behaven Kids BCBA team as assigned by clinical leadership
Assist with conducting assessments, functional behavior assessments (FBAs), and reassessments as needed
Develop, review, and update behavior intervention plans (BIPs) and treatment goals in collaboration with supervising BCBAs
Provide supervision, observation, and clinical feedback to RBTs and other direct care staff as needed
Complete treatment plan reviews, progress reports, and other required clinical documentation to ensure compliance with payer and regulatory requirements
Assist with parent and caregiver training sessions
Provide temporary clinical coverage during BCBA absences, PTO, vacancies, or periods of increased clinical need
Collaborate with clinic leadership to maintain continuity of client care during staffing transitions
Participate in interdisciplinary collaboration with other providers and team members when appropriate
Assist with onboarding, mentoring, and clinical training of new BCBAs and RBTs as requested

What we offer

Vibrant, collaborative, team-oriented work environment
Diverse and inclusive work environment
Direct mentorship and access to Dr. Paula Kenyon, PhD, BCBA-D
Attractive benefits package

Parttime

Senior Business Analyst

The Senior Business Analyst will support the client’s contractors with obtaining...

Location

United States , Albany

Salary:

71400.00 - 135000.00 USD / Year

NTT DATA

Expiration Date

Until further notice

Requirements

Minimum eight (8) years of experience fostering strong working, business partnering relationships and communication with clients, key internal and external stakeholders and executive staff
ensuring teams are aware of CMS policies
Minimum three (3) years of experience implementing the CMS certification process on Medicaid programs with deep understanding of CMS policies and how they impact systems
Minimum five years of experience managing requirements
Minimum five years of experience preparing Business Process Design documentation using BPMN 2.0 and related models
Minimum five years of experience working with teams of five or more staff
Minimum five years of experience with business process models and/or use cases
Bachelor’s degree in information technology, Business Administration or similar field
This position requires 50% onsite, so local candidates required

Job Responsibility

Review, evaluate and validate mandatory MES systems and subsystems to determine compliance with core CMS Federal certification requirements
Coordinate certification activities with client’s contractors and staff
Establish checklists for CMS onsite visits
Attend meetings with client and CMS staff. Prepare agenda, meeting notes, decision lists and follow up action items
Support of CMS Federal certification review team/CMS Regional Office staff briefings and pre-certification meetings and calls
Assist with preparations for CMS on-site visits
Analyze data, reports, and deliverables, as needed
Assist with resolution of any CMS Federal certification issues
Review of CMS Federal certification report(s) and provide additional guidance to Department and its Contractors
Support the preparation of Department responses to CMS

What we offer

Medical insurance
Dental insurance
Vision insurance
Flexible spending or health savings account
Life and AD&D insurance
Short and long term disability coverage
Paid time off
Employee assistance
401k program with company match

Fulltime

Technical Specialist 4/ TS4

Technical Specialist (TS4) plays the role of lead Salesforce developer and is re...

Location

United States , Columbus

Salary:

Not provided

Dash Technologies

Expiration Date

Until further notice

Requirements

Bachelor’s degree in computer science or information systems or related field
More than 10 years of experience in Information systems in Analysis, Design & Development
Required 5+ years of Professional Experience in development & administration of applications in Salesforce platform-based technologies (Sales Cloud, Service Cloud, Community Cloud)
Required 5+ years of Experience in Aura Components, Lightning Web Component Framework Apex, SOQL development, VisualForce, Java Script, HTML and CSS
Required 5+ years of experience in SFDC Design, Analysis, Configuration, Customization and Coding
Required 5+ years of experience with SFDC data model and the data migration / integration capabilities of SFDC
Required 3+ years of experience handling integrations using API’s or web services with other internal and 3rd Party systems using REST or SOAP
Required 4+ years of Experience in building and Managing Communities
Required Minimum of 5 years of experience using Salesforce tools such as Data Loader, Flosum, SFDC Outlook connector, Ownbackup, Jitterbit etc.
Required 1+ years of experience handling Salesforce and Outlook integration

Job Responsibility

Acts as lead Salesforce CRM developer and works very closely with Business Analysts, Architects & Project managers in planning the releases
Work with business teams to understand their processes and translate their needs into actionable salesforce requirements for configuration/development
Involved in all aspects of the Project life cycle, from the initial kickoff through the requirements analysis, design, implementation, testing and post-production solution and user support
Maintains and provides enhancements to the existing Salesforce solutions using latest features
Familiar with Salesforce.com best practices related to release management and deploying changes through the various sandboxes to production
All aspects of user and license management including new user setup/deactivation, roles, profiles, permissions, public groups, OWD, sharing rules
Data management to improve Salesforce data quality, implementing rules and automation as needed
Provide ad hoc data extracts as per business area needs
Proactive system maintenance including Security Reviews, Release Updates, Health Check, and Optimizer
Identify unused or underutilized platform features

Fulltime

Compliance Analyst II

As a community, the University of Rochester is defined by a deep commitment to M...

Location

United States of America , Rochester

Salary:

63815.00 - 95723.00 USD / Year

University of Rochester

Expiration Date

Until further notice

Requirements

Bachelor or Associate’s degree in a related field preferred
Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered
Minimum of 3 years of healthcare coding experience required to include APG, APC, and/or DRG coding methodologies or professional coding and billing in specialty areas
Experience in a direct or supporting role within healthcare compliance preferably within an integrated health system or Academic Medical Center or other comparable setting
Strong communication, interpersonal, and public speaking skills required
Ability to efficiently produce clear, concise, and complete written audit reports required
Excellent analytical, organizational, and problem-solving skills required
Demonstrated objectivity and critical thinking in analyzing situations
must be able to evaluate facts without bias and avoid unsupported assumptions required
Ability to manage projects and effectively advise staff in a motivational and positive manner required

Job Responsibility

Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates in accordance with the OIG and OMIG compliance program guidance
Evaluates adherence to coding and billing regulations and guidelines through review, research, and analysis
Serves as a compliance resource, developing and delivering comprehensive education and training
Conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud, waste, and abuse, specifically addressing the DRA, NY SSL § 363-d, and 18 NYCRR SubPart 521
Analyzes billing data to identify potential risk areas related to professional and/or facility payment systems
Performs audits of medical record documentation to ensure compliance with coding and billing requirements as defined by AMA, AHA, HCPCS, CMS and Medicaid guidelines
Creates and provides reports on findings to relevant stakeholders
Responds to reported compliance concerns by conducting formal investigative activities
Performs root cause analysis when deficiencies are identified
Collaborates with relevant stakeholders to determine improvement opportunities to mitigate future risk

Fulltime

Documentation & Risk Coding Analyst - Hospital Based

Will support - Hospital Based Coding. Standard dept operating hours Mon-Fri. 6am...

Location

United States , Remote; Milwaukee

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Completion of advanced training through a recognized or accredited program, equivalent in scope and rigor to post-secondary education or equivalent knowledge
High school diploma or GED required
Minimum of 4 years of healthcare experience, including at least 2 years working as a clinician or in direct partnership with clinicians or recognized profession supporting clinicians (i.e. CDI, CMD or informatics), with demonstrated involvement in clinical documentation, coding, or documentation improvement initiatives
Extensive knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage determinants, research-related restrictions, ICD-10 CM/PCS, and CPT/HCPCS coding classifications
Demonstrated proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, etc.) or similar products and in patient accounting and billing systems
Ability to deal and work effectively with multiple departments and in matrix organizational structures
Strong oral and written communication skills
Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment
Highly proficient in problem-solving and strong attention to detail
Advanced knowledge of Epic

Job Responsibility

Demonstrates full understanding and is compliant with regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS), Medicare National Correct Coding Initiative edits and other payers
Partners with Coding, CDI, CMD and Quality professionals and others to advance documentation improvement practices
Exhibits and promotes a professional team-oriented service culture to achieve intended outcomes
Reviews clinical documentation and diagnostic results from the EHR to ensure appropriate assignment of the ICD-10-CM/PCS and/or ICD-10-CM CPT/HCPCS codes to support organizational and Clinician Services initiatives
As indicated, queries providers when existing documentation is unclear or ambiguous following established organizational policy
Partner within sub-function leadership and team members to identify opportunities for improvement based on analysis and review
Demonstrates positive collaboration with team members within Clinician Services and other organizational stakeholders
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines as well as the organizational and departmental guidelines, policies and protocols
Demonstrates technical competence to use EHR, other software applications and official coding resources
Maintains confidentiality of patient records. Reports any perceived non-compliant practices to the Documentation and Risk leadership or compliance officer

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Opportunity for annual increases based on performance
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions

Fulltime

Documentation & Risk Coding Analyst - Hospital Based

Will support - Hospital Based Coding. Standard dept operating hours Mon-Fri. 6am...

Location

United States , Milwaukee

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Completion of advanced training through a recognized or accredited program, equivalent in scope and rigor to post-secondary education or equivalent knowledge
High school diploma or GED required
Minimum of 4 years of healthcare experience, including at least 2 years working as a clinician or in direct partnership with clinicians or recognized profession supporting clinicians (i.e. CDI, CMD or informatics), with demonstrated involvement in clinical documentation, coding, or documentation improvement initiatives
Clinical or operational credential required. May include licensure as a clinically practicing professional (e.g., RN, RT, LCSW) or Certification in healthcare operations or project management (e.g., PMP, LSSGB, HFMA-CRCR)
Certification in mid-revenue cycle operations from a recognized professional organization such as AHIMA, AAPC, or HFMA is required
Candidates without a certification in mid-revenue cycle from a recognized professional organization will be required to obtain one within 12 months of hire
Extensive knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage determinants, research-related restrictions, ICD-10 CM/PCS, and CPT/HCPCS coding classifications
Demonstrated proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, etc.) or similar products and in patient accounting and billing systems
Ability to deal and work effectively with multiple departments and in matrix organizational structures
Strong oral and written communication skills

Job Responsibility

Demonstrates full understanding and is compliant with regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS), Medicare National Correct Coding Initiative edits and other payers
Partners with Coding, CDI, CMD and Quality professionals and others to advance documentation improvement practices
Exhibits and promotes a professional team-oriented service culture to achieve intended outcomes
Reviews clinical documentation and diagnostic results from the EHR to ensure appropriate assignment of the ICD-10-CM/PCS and/or ICD-10-CM CPT/HCPCS codes to support organizational and Clinician Services initiatives
As indicated, queries providers when existing documentation is unclear or ambiguous following established organizational policy
Partner within sub-function leadership and team members to identify opportunities for improvement based on analysis and review
Demonstrates positive collaboration with team members within Clinician Services and other organizational stakeholders
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines as well as the organizational and departmental guidelines, policies and protocols
Demonstrates technical competence to use EHR, other software applications and official coding resources
Maintains confidentiality of patient records. Reports any perceived non-compliant practices to the Documentation and Risk leadership or compliance officer

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Opportunity for annual increases based on performance
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions

Fulltime

New

Ai Engineer

We are recruiting an AI Engineer for a direct contract with a company based in t...

Location

Portugal , Porto

Salary:

Not provided

Precise

Expiration Date

Until further notice

Requirements

2+ years experience working within a software development team as an engineer
Comfortable writing and debugging code in Python. You understand the importance of readable code and are eager to learn best practices.
Familiarity with frameworks like FastAPI, Flask, or Django, with experience developing and exposing/consuming APIs.
Understanding of containerization and exposure to Docker.
Comfortable using Git for team collaboration (Gitlab pipelines exposure is a plus).
Machine Learning Fundamentals: Foundational knowledge of ML concepts and practical experience (academic or personal projects) deploying a simple model using libraries like scikit-learn, PyTorch, or TensorFlow.
Experience manipulating and analyzing data using libraries such as Pandas and NumPy.
A strong desire to learn MLOps principles, cloud infrastructure, and deployment practices (Kubernetes exposure is a plus).
BSc in Computer Science or a related technical field.

Job Responsibility

Implementing solutions for building and deploying AI models in production, with a focus on fault tolerance, scalability, maintainability and automation.
Leveraging modern LLM’s to include/enhance parsing capabilities for CVs/job adverts for existing supported languages and new additional languages.
Collaborating with the team to design, implement and optimise data processing pipelines and evaluation tools.

Fulltime

New

Branch Manager

Come and join us as a results driven Branch Manager to deliver sales and exceed ...

Location

United Kingdom , Lymington

Salary:

Not provided

City Plumbing

Expiration Date

Until further notice

Requirements

A great positive attitude
Enjoy customer interaction
Management Experience
Safe Practices
Forward Thinking
Tenacity and resilience
A pro-active approach to sales, with a strong desire and ability to win and grow new business
Experience of customer relationship management and developing a true partnership approach
Excellent communication skills
Self confident and self motivated, with the ability to work on own initiative or as part of a wider team

Job Responsibility

Effective management of the team and resource
Setting the standard of a sales orientated culture
Delivering against sales and customer demands while maximising profitability
Maximising margin and net profit
Keeping everyone safe
Build and maintain relationships with new and existing trade and retail customers
Ability to interpret and analyse financial and statistical information

What we offer

Bonus
Discounts, savings and cash back at numerous retailers
Life assurance
Extended family policy including maternity, paternity, additional annual leave and more
Mental Health First Aiders and Employee Assistance Programme, we look out for each other
Complete induction and a company that lets you grow and encourages development
Financial education and loans
Flexible working options
A business striving to create an environment of inclusion so everyone can be their true self

Fulltime

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Medicaid Certification Analyst

Job Description

Job Responsibility

Requirements

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What we offer

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