at State of Vermont in Waterbury, Vermont, United States
Job Description
OverviewThe Department of Vermont Health Access (DVHA) Coordination of Benefits (COB) Unit is seeking a skilled and knowledgeable Health Care professional to join the COB Recoveries team. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. Twelve paid state holidays, in addition to a robust benefits package.
The Program Consultant role serves as the subject matter expert for the following work processes with the COB Recoveries Team:
· Centers for Medicare & Medicaid (CMS) Enterprise Portal for:
o Medicare Advantage Prescription Drug (MARx user interface)
o Eligibility and Enrollment Medicare Online (ELMO)
· Casualty Recoveries
· Choices for Care Long-Term Care Patient Share Recoveries
· Choices for Care Long-Term Care Over Resource Recoveries
· Estate Recoveries
· Annuity & Trust Recoveries
The Program Consultant position has the following responsibilities:
· Case management and accounting for all COB Recoveries areas
· Collaborating with internal and external stakeholders.
· Interpreting and applying complex billing and coding rules
· Interpreting and applying complex health care eligibility rules for multiple programs
· Conducting research and analysis on eligibility issues
· Overseeing procedural development.
· Ensuring compliance with federal and state regulations.
· Conducting research and analysis on policy rules
· Conducting research and analysis on third-party liability rules
· Managing escalated cases.
· Supporting system enhancements and compliance.
· Contributing to policy development, special projects, program evaluation, and the creation of standard operating procedures and training materials.
Key Skills & Competencies:
· Subject Matter Expertise: Advanced knowledge of health care program rules and business processes, with the ability to interpret and apply regulations accurately.
· Consultative & Evaluative Skills: Ability to evaluate policies, procedures, and regulations and recommend improvements based on program analysis.
· Analytical & Problem-Solving Skills: Strong analytical skills for reviewing complex legal and regulatory documents, as well as resolving escalated cases.
· Collaboration & Communication: Excellent communication skills, both verbal and written, with the ability to liaise effectively with a wide range of stakeholders, including department staff, external partners, and policy analysts.
· Project Management: Experience managing special projects, working under tight deadlines, and ensuring that program outcomes are met in a timely and efficient manner.
· Adaptability: Ability to work in a fast-paced environment, balancing multiple tasks and responsibilities while maintaining attention to detail and accuracy.
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.
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.
