JOB TITLE: Specialist, Beneficiary Relations
LOCATION: Little Rock, AR
FLSA STATUS: Exempt
SCOPE OF POSITION:
Responsible for the development, implementation, and monitoring of a Medicaid Managed Care Services (MMCS) specialty areas related to AFMC’s contractually driven projects. Serve as a subject matter expert on assigned project/contract. Provide communication, education and promotion of program services. Collaborate with medical and other professional staff to meet contract deliverables within designated timeframes. Communicate with MMCS staff and beneficiaries ensuring timely provision of services and appropriate follow up. Document services rendered and provider reporting as required.
ESSENTIAL JOB FUNCTIONS:
1. Manage the overall planning, development, implementation, and evaluation of specialty area as necessary to fulfill contractual obligations.
2. Maintain comprehensive knowledge of specialty area, pertinent organizations, and health care environment. Knowledge should include information regarding: contract, contract deliverables, policies and procedures, resources available, current research and reports, trends, etc.
3. Responsible for the resolution of customer/client requests including research, referral, policy review, revision and development, documentation and follow up in accordance with established policy/procedures.
4. Communicate effectively with customers and/or recipients. Develop and maintain working relationships as necessary to meet contract deliverables of specialty area project.
5. Act as a resource to internal and external customers for information pertaining to specialty area focus. Serve as AFMC representative at various external functions, as directed.
6. 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.
7. Coordinate the timely collection and data entry of all required documentation.
8. Assist in the creation and maintenance of necessary forms, publications, reports, and additional documents to track and report project information. Prepare monthly reports and/or statistics as directed.
9. Monitor specific items within the area of focus, provide recommendations/ feedback to external customers for quality improvement and follow through for compliance of recommendations for improvement.
10. Identify, present, and discuss progress and issues relating to specialty area and implement solutions to assist in program development. Ensure all activities address designated performance goals, the appropriate target audience, and are performed within designated time frame.
11. Training and knowledge in all other areas of Beneficiary Relations to assist as needed with the overall operation of the Beneficiary Relations department.
12. Assist in the development, production, maintenance and delivery of educational materials/activities.
13. Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
14. Communicate needs and requests to other team members as appropriate.
15. Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
16. 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 needed. 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: Bachelor’s degree in health sciences field, business or related field. May require a specific license in one or more of the following areas, dependent upon position: EMT, Paramedic or Certification for inspection of vehicles, etc 1
Required: Three (3) years in the focus area of the position which includes, ambulatory care, emergency transportation, case management, customer relations, vehicle maintenance, etc.
Desirable: Experience within the healthcare arena, knowledge of the government procurement cycle and understanding of the Medicaid Guidelines and/or QIO experience
KNOWLEDGE, SKILLS AND ABILITIES:
Must possess intermediate level computer skills (Excel, Word, Power Point and Outlook)
Type 50 wpm
Exceptional skills in business English and spelling
Ability to maintain confidentiality
Strong oral and written communication skills
Ability to meet deadlines
Attention to detail
Knowledge of ICD 9 Coding
Knowledge of HIT/EHR
Ability to work collaboratively and independently to achieve stated goals
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
Project management skills
Ability to read, interpret and apply laws, rules and regulations
Knowledge of quality improvement processes and techniques
Valid driver’s license
Ability to travel including overnight travel
Time management skills
1 Five (5) years work experience in related field may be substituted for the Bachelor’s degree. If work experience is substituted it is in addition to stated work experience requirements.