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Response to RFP No. MED13002 State of West Virginia ... - DHHR

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Request For Proposal #

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services certifications necessary to meet and exceed the expectations of the West Virginia Department of Health and Human Resources, Bureau of Medical Services (BMS). As you will see, our level of proficiency in the intricacies of provider billing enables the rapid discovery and recovery of over/under payments. For the West Virginia’s engagement PRGX will maintain staffing levels sufficient to complete all of the services and meet the requirements specified in this RFP and the resulting Contract. We are prepared at all times to recruit properly licensed and certified staff, as required to implement all aspects of the services required in this RFP within the stated timeframes. Furthermore, we assure the BMS that all persons assigned by PRGX to perform functions under the resulting Contract, whether they are employees, agents, subcontractors, or anyone acting for or on behalf of the Contractor, are properly licensed and certified as required under applicable state and federal laws and regulations and as defined below to perform the functions assigned to them. While the credentials and experience of our auditors vary, each individual including the members of our audit staff who would be assigned to BMS, are appropriately credentialed and experienced to handle BMS’ Medicaid recovery audit requirements. Our physicians, registered nurses, certified coders, and contract compliance specialists use an extensive library of proprietary concepts and algorithms designed to identify inappropriate medical claim payments to improve our clients’ bottom line. Through a collaborative and cross‐functional team effort, our staff identifies potential improper payments made by the State of West Virginia to Medicaid providers; by analyzing paid claims data and reviewing corresponding medical records to determine administrative compliance, coding and billing and medical necessity. 41

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services Organizational Chart Roles, Responsibilities and Skills Project Director The Project Director will be responsible for the overall direction, coordination, implementation, execution, control and completion of the West Virginia recovery audit project ensuring consistency with the state’s requirements and the company’s strategy, commitments and goals. The Project Director has clear authority over the entire operation. Serve as a point of contact for specific problems, and has the authority to make decisions and resolve problems on behalf of PRGX. Duties and Responsibilities: ♦ Leads the planning and implementation of project ♦ Efficiently synthesize project information and accurately establish project scope ♦ Set project costs and productivity benchmarks ♦ Successfully manage and control budgets ♦ Develop good working relationships with stakeholders at all levels to build consensus ♦ Solve critical issues in a time‐sensitive environment ♦ Facilitate project resource allocation 42

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