DVHA Program Consultant

State of Vermont•Waterbury, VT

2d•Hybrid

About The Position

The DVHA Program Consultant in the Coordination of Benefit unit works, analyzes, and oversees various reports and client cases. This role involves generating and pulling reports of claims where further investigation on a primary payer is required. The program consultant works with reports and cases referred to the unit, focusing on the investigation of primary commercial medical or pharmacy insurance or primary Medicare coverage. The consultant collaborates with primary commercial and Medicare carriers, CMS, pharmacies, various DVHA departments, outside contractors, Medicaid's Pharmacy Benefit Manager, and claims processors to resolve caseload referrals. The position also assists in resolving live access to care billing issues to support clients' ability to obtain necessary health coverage. Additionally, the Program Consultant will participate in projects related to Coordination of Benefits and may be required to perform monthly financial reconciliation reporting for the department's Coordination of Benefits collections.

Requirements

Two (2) years or more of experience in a healthcare or health insurance field.
Experience in either accounting, auditing, federal grants management, business administration or public or health administration.

Nice To Haves

Bachelor's degree
One (1) year or more of experience in a healthcare or health insurance field.
Experience in accounting, auditing, federal grants management, business administration or public or health administration.

Responsibilities

Works, analyzes, and oversees various reports and client cases within the Coordination of Benefit unit.
Generates and pulls reports of claims requiring investigation of a primary payer.
Investigates primary commercial medical or pharmacy insurance or primary Medicare coverage for referred cases.
Collaborates with primary commercial and Medicare carriers, CMS, pharmacies, DVHA departments, outside contractors, Medicaid's Pharmacy Benefit Manager, and claims processors to resolve caseload referrals.
Assists in resolving live access to care billing issues to aid clients in obtaining health coverage.
Participates in projects and other related duties concerning Coordination of Benefits.
May perform monthly financial reconciliation reporting for the department's Coordination of Benefits collections.