at State of Vermont in Waterbury, Vermont, United States
Job Description
OverviewDVHA Program Consultant in the Coordination of Benefit unit works, analyzes and oversees various reports and client cases. Program Consultants generates and pulls reports of claims where further investigation on a primary payer is required. The program consultant works reports as well as cases referred to the unit, regarding investigation of a primary commercial medical or pharmacy insurance or primary Medicare coverage. Program Consultant works with primary commercial and Medicare carriers, CMS, pharmacies, various DVHA departments and outside contractors, Medicaid's Pharmacy Benefit Manager and claims processor to help resolve caseload referrals. Program Consultant helps resolve live access to care billing issues to assist clients and their ability to obtain health coverage needed. Program Consultant will participate in projects or other related duties that relate to Coordination of Benefits. The position may require monthly financial reconciliation reporting for the department Coordination of Benefits collections.
Mission:
The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.
Diversity, Equity, and Inclusion:
As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.
Our State:
Vermont is a "small but mighty" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.
Work is generally performed within the normal office setting.
Some means of private transportation must be available for field visits. Work activities during the evening or weekend may occur, and some out-of-state travel may be required. Conflicting opinions relative to the correct application of rules, regulations and policies can be anticipated.
