layiq

/la·yiq/adjective

worthy; deserving; fitting; suitable.

A role, opportunity, or path that merits attention, time, and pursuit.

Medicaid Claims Operations Manager at General Dynamics Information Technology | LAYIQ

Manage and oversee day-to-day MES claims operations, ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual Service Level Agreements (SLAs).
You will act as a thought partner to the leadership team to provide support and counsel for operations management, communications, initiatives and projects.
You should be a self-starter with outstanding organization and communication skills; fast-paced environment.
Understand strategic financials regarding areas of oversight.
Proven ability to build strong partnerships with colleagues, desire to be flexible and think proactively, strategically, and analytically about diverse business solutions and leading professional working groups.
Ability to make critical decisions with limited guidance while ensuring visibility into those decisions.
A demonstrated understanding of Medicaid support operations and an appreciation for how to prioritize among demands and balance the levers that make a complex business run smoothly and productively.
Manages Provider Enrollment operations for the program, including optimizing resources to facilitate SLA deliverables and maximize efficient operations.
Manages change management efforts and reporting to optimize SLAs and ensure optimization of resources.
Serve as lead cross departmental deliverables for operations, including internal and external audits, business continuity, and other program operations deliverables.
Serve as a resource for operational managers and assist with training and mentoring operational managers regarding key operational processes.
Lead cross departmental operational efforts for internal and external quality assessments, audits and surveys.
Lead cross departmental communication initiatives to both internal and external stakeholders, including community engagement efforts and efforts to facilitate employee engagement.
Manage and oversee key departments, including training and operational data efforts to optimize efficiencies and ensure effective operations.
Oversee and coordinate NCQA CVO efforts and all supporting efforts.
Manages and optimizes customer and key stakeholder relationships, including escalations and developing processes to facilitate timely management of provider enrollment related escalations.
Required Skills and Qualifications
Education: Bachelor's Degree in related technical, scientific, business, health or a related discipline
Required Experience: 5+ years of related experience
Required Skills and Abilities: Medicaid Operations Leadership Support , Project Management Skills, Provider Enrollment Management Skills and Experience, NCQA CVO knowledge and experience.
Demonstrated ability to communicate issues, impacts, and corrective actions
Preferred Skills: SharePoint, Excel, PMO, PowerPoint
Strong knowledge of Medicaid Fee-for-Service (FFS), and Managed Care claims processes.
Experience with healthcare claims software platforms and operational workflows.
Experience in claims repricing and interaction with national coding standards (e.g., CPT, ICD-10, HCPCS).

Medicaid Claims Operations Manager

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