SCOPE OF POSITION:
Responsible for the onsite validation of enrollment applications requested by DMS/DHS. The Specialist Provider Validation will conduct onsite validation surveys of Medicaid provider enrollees and will collaborate with other professional staff to meet contract deliverables within designated timeframes. Communicates with AFMC outreach staff to ensure timely execution of surveys, appropriate follow up, documentation and submission to the state. Responsible for working with other outreach teams that support achievement of contract deadlines and deliverables.
ESSENTIAL JOB FUNCTIONS:
- Conduct onsite surveys requested by DMS to validate enrollment application of Medicaid healthcare providers.
- Maintain knowledge of Arkansas Medicaid enrollment data elements, survey process requirements, provider types, and health care environments. Knowledge should include information regarding: contract, contract deliverables, policies and procedures and resources available.
- Communicate effectively with stakeholders and Medicaid provider enrollees. Develop and maintain working relationships as necessary to meet contract deliverables.
- Understand and utilize project-tracking database to document and monitor services/activities provided and to compile a comprehensive database of activity. Maintain accurate statistical data to meet contractual and other reporting requirements.
- Coordinate the timely collection and data entry of all required documentation.
- Maintain knowledge in all other areas of Medicaid provider enrollment validation surveys to assist as needed with the overall operation of the High Risk Provider survey team.
- Communicate needs and requests to other team members as appropriate.
- Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
- Additional duties as assigned.
PHYSICAL AND SENSORY REQUIREMENTS (WITH OR WITHOUT THE AID OF MECHANICAL DEVICES):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as required. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.
Required Skills
KNOWLEDGE, SKILLS AND ABILITIES:
- Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook)
- Must possess basic document creation skills, including scanning, uploading, attaching documents
- Type 50 wpm
- Exceptional skills in business English and spelling
- Ability to maintain confidentiality
- Strong oral and written communication skills
- Creativity
- Customer service
- Ability to meet deadlines
- Attention to detail
- Flexibility
- Medical terminology
- Ability to work collaboratively and independently to achieve stated goals
- Initiative
- Ability to relate professionally and positively with staff, business partners, customers, constituents, beneficiaries and the public
- Ability to multitask
- Ability to prioritize
- Strong organizational skills
- Problem solving skills
- Professionalism
- Project management skills
- Ability to read, interpret and apply laws, rules and regulations
- Valid driver’s license, reliable transportation and auto insurance.
- Extensive travel including overnight travel required.
- Time management skills.
- To work remotely staff must have an internet connection of sufficient speed and reliability to perform his or her work efficiently. A minimum of 10 mbps, verifiable by IT staff, is required. Your internet connection and network/equipment usage must comply with the AFMC Employee Handbook.
Required Experience
EDUCATION:
Required: Associate’s degree in health sciences field, business or related field. [1]
[1] One (1) year minimum experience in healthcare credentialing may be substituted for the Associate’s degree. If work experience is substituted it is in addition to stated work experience requirements.
Desirable: Bachelor’s degree in health sciences field, business or related field.
EXPERIENCE:
Required: One (1) year in a healthcare setting.
Desirable: Three (3) years’ experience within a healthcare setting
Equal Opportunity Employer/Veterans/Disabled EEO IS THE LAW
AFMC, Inc. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability or any other status protected by federal, state and/or local law. AFMC invites any employee and/or applicant to review the Company’s Affirmative Action Plan. This plan is available for inspection upon request, which may be made in person or by telephone (501) 212-8798, by fax (501) 212-8797 or by U.S. mail Attn: Michael Dumas, 1020 West 4th Street, Suite 300, Little Rock, AR 72201.