C/S Health Care Cost Containment Specialist

State of Delaware•Dover, DE

48d

About The Position

Make a Difference with DHSS Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas. We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession. For more information, please visit https://dhss.delaware.gov/dhss/ today! Summary Statement The incumbent in this position will assist Community Health Clinics in all three counties with insurance credentialing and provider enrollment activities in collaboration with administrative staff and insurance companies. The position reviews insurance claim denials in correlation with client electronic medical record (EMR) documentation to identify discrepancies, support reimbursement, and improve claims resolution. Maintains records, communicates with insurance carriers, and supports operational efficiency through coordination and adherence to clinic processes and procedures.

Requirements

Three years experience in health care cost containment such as analyzing health care costs and recommending delivery systems and reimbursement procedures.
Six months experience in developing policies and procedures.
Six months experience in interpreting health care laws, rules, regulations, standards, policies and procedures.
Six months experience in health or human services program administration such as overseeing and directing the development, implementation and evaluation of health or human services programs and services; planning and establishing short and long range program goals and objectives.
Providing advice to other agency organizational units through consultation.
Knowledge of managing budgets, grants or contracts.
Knowledge of staff supervision acquired through course work, academic training, training provided through an employer, or performing as a lead worker overseeing the work of others; OR supervising staff which may include planning, assigning, reviewing, and evaluating the work of others; OR supervising through subordinate supervisors a group of professional, technical, and clerical employees.

Responsibilities

Serves as Department's technical expert in the highly complex areas of health care cost containment.
Manages, directs and/or performs specialized studies which result in alternative health care delivery systems and methodologies.
Supervises staff as needed when directing any project.
Provides technical expertise to other Divisions, within the Department, in the areas of policy development, research and evaluation, reimbursement methodologies and health care cost containment initiative.
Collects and analyzes varied and complex data used in support of report, project and funding development purposes.
Serves on or coordinates special committees, task forces, and working groups involved in strategic planning, policy development, service delivery and cost containment projects for the Department.
Analyzes reports and documents from federal, state and the department and recommends cost containment policy changes.
Prepares annual legislative Health Care Cost Containment Report which outlines the Department activities in this area.
Keeps abreast of legislative and technical developments and change related to the area.
Works with other state, local or private agencies that are affected by cost containment policy changes.