The Medicaid Quality Manager supports the service, billing and clinical requirements of Integrity’s Medicaid funding. S/he works closely with both financial and clinical staff to design and improve underlying processes used to document and bill for Medicaid. The Medicaid Quality Manager acts as the agency expert in Medicaid requirements for behavioral health services. S/he provides training, improves/streamlines information flow, reviews client and billing files, recommends improvements and ensures they are implemented.
Responsibilities include, but are not limited to the following:
• Evaluate current clinical documentation practices against Medicaid requirements to identify gaps and propose process improvements
• Design and conduct ongoing training for program directors, counselors and other direct care staff to ensure standards are met.
• Work with agency’s Electronic Health Record team to increase the system’s capability to capture data in a Medicaid funded environment.
• Work with the agency’s Director of Billing Services to improve the Medicaid revenue cycle. Strengthen processes for monitoring client eligibility, billing claims, monitoring claims, and reconciling/recovering outstanding payments.
• Perform internal monitoring and propose process improvements.
• Stay abreast of state and federal changes to Medicaid eligible services and help the agency prepare for future changes.
• Guide Integrity’s contracting process with New Jersey Family Care Managed Care Organizations.
• Provide assistance to programs in outreach to Medicaid eligible clients to expand their easy access to addictions treatment and support.
Job qualifications include:
• Bachelor’s Degree, Master’s a plus
• 3-5 Years of experience in Medicaid training, billing implementation and/or quality assurance
• Ability to work in a team environment to provide solutions to problems
• Experience in developing and improving workflow systems.
• Strong understanding of Behavioral Health service delivery – inpatient and outpatient settings
• Knowledge of claim processes and systems
• Ease with Technology (Electronic Health Record, Spreadsheet Skills, Financial Interfaces)
• Analytical Thinking
• Ability to respond to a high volume of work and maintain a polite and professional manner at all times. Must demonstrate a positive attitude.