PCS Compliance (Chisolm) – Coordinator 1


DEPARTMENT

Medicaid Technical Services Contract


POSITION SUMMARY

 (1 Position located in Baton Rouge)

 


RESPONSIBILITIES

• Assist the Chisholm Compliance Officer in monitoring 3 MCOs for compliance with all Chisholm Orders and Stipulations. • Daily look for new PA’s for Extended Home Health and EPST Personal Care Services. • Analyze each PA to ensure that the notice meets all Chisholm requirements and communicate any issues with that notice to the MCO, Molina and the Chisholm Compliance Officer. • If a request is Denied o Determine if it should have gone to the internal Prior Authorization PAL o Determine if the PA went to the internal Prior Authorization PAL. o Determine if the PAL was properly followed o Coordinate with DHH EPSDT Personal Care Services and Home Health manager to determine if policy was appropriately applied when denying services. o Determine if the case was Chronic Needs. o Determine if the member was previously approved to receive the service by Molina or another MCO. o Determine if the member was previously approved for the service and if so there was a change in condition o Document all of this and forward it to the Program Manager for Review and approval before communicating issues to the MCO or Molina. • Conduct random check of the MCO external PAL (PAL that tracks and receives PAL referrals from Support Coordinators) • Work with Program Manager and your counterparts to create a system to track PAL referrals that are sent MCOs, • For all CCMs enroll in a Health Plan Monthly track all new CCMs that have enrolled in the MCOs. o Per class member enrolled in an MCO identify all previously authorized by Molina. o Track MCO authorization to assure services are continued as for 60 days or longer if the member has been deemed Chronic Needs or there has been no change in the member’s condition. • Organizes and files related paperwork. • Other tasks as directed.


REQUIRED QUALIFICATIONS

• Bachelor's degree or 6 years of professional work experience in lieu of degree. • Excellent analytical skills, effective organizational and time management skills. • Great attention to detail and follow up, and verbal/written communications skills. • Able to set, follow and meet scheduled deadlines


DESIRED QUALIFICATIONS

• Advanced degree • Early Periodic Screening Diagnostic Treatment Personal Care Services (EPSDT PCS), legal/paralegal, or home health background/experience. • Professional experience in dealing with federal/state health care programs. • Professional experience working with Microsoft Word, OneNote, SharePoint and/or Excel. • Minimum 1 year of professional experience with compliance and/or project management activity. • Professional experience in health care field or Medicaid program support. • Knowledge of the Louisiana Medicaid Programs. • Relevant industry related certifications.


SALARY

Commensurate with qualifications and experience.


DATE POSTED

04/02/2018


CLOSING DATE

Position will remain open until filled.


POSITION NUMBER

9378

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