Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006ROLE RESPONSIBILITIES SKILL SETEDI data received from providers, clearing communication skillshouses, and billing agencies Resolves problems related to specific EDIdocuments that generate 997, TA1 and 824errorsEnrollmentAnalystExtract,Transform,and LoadDevelopersWorks with vendors/trading partners toidentify, define, develop, and implementchanges to correct errorsManages EDI projects and communicatedirectly with providers, clearinghouses andbilling agencies in a call center settingReads, understands and professionallycommunicates Extensible Markuplanguage(XML) data and ANSI X12format including 835 and 837 Professional,Institutional and Dental formatsPerforms provider assistance with directdata entry (DDE) submission of claims,270/276 transactions, retrieval of electronicremittance advices and related reports onthe MMIS Web portalPerforms provider enrollment and reenrollmentfunctionsPerforms provider re-validationEnsures all State and Federal guidelines forenrollment and re-enrollment are met(including PPACA rules and regulations)Maintains provider demographic datawithin the MMISAssigns provider enrollment/re-enrollmentstatusVerifies all providerenrollment/reenrollment documentation,including licenses and certifications isreceived; follow up with providers whereadditional documentation is neededRefer evidence or reports of Providerfraud/abuse/exclusion to BMS and/or itsdesignee on a monthly basis.Distribute provider enrollment materialsincluding a welcome packageResponds to provider inquiries specific toprovider enrollment/re-enrollmentProvides guidance to site managementincluding cost analysis. Also providesguidance to other teamsProvides guidance to other teams regardingETL questions and issuesProvides guidance to the infrastructureteam for ETL application serverStrong organizational skills, attention todetail and problem solvingAbility to perform tasks with a high degreeof accuracyBachelor’s degree or equivalentexperienceTwo years of experience in the health carebilling or health care public relations fieldsExperience with Microsoft OfficeKnowledge of FileNET document classes,indices and distribution queuesKnowledge of Cincom (Letter Manager)and Call Center Toolsets (ContactManager)General knowledge of a personal computerGood verbal and written communicationskillsBachelor’s degree or equivalentexperienceThree to five years analysis experienceThree to five years ETL design and/ordevelopment experienceThree to five years database experience in14.4-23