NC Medicaid Consultant

World Relief•Durham, NC

80d

About The Position

World Relief is a global Christian humanitarian organization whose mission is to boldly engage the worldâs greatest crises in partnership with the church. The organization was founded in the aftermath of World War II to respond to the urgent humanitarian needs of war-torn Europe. Since then, for 80 years, across 100 countries, World Relief has partnered with local churches and communities to build a world where families thrive and communities flourish. Today, organizational programming focuses on humanitarian and disaster response, community strengthening and resilience, and refugee & immigrant services and advocacy. World Relief Durham is seeking proposals for a Lead Consultant to assist with effective implementation and growth of NC Medicaid managed care services, offer assessment and strategic planning services, in collaboration with other key stakeholders to be identified.

Requirements

Medicaid Expertise: Deep knowledge of NC Medicaid managed care, including eligibility criteria, billing codes, and reimbursement rates specific to mental health services for refugees and immigrants (specifically, interactive complexity and other related dynamics).

Nice To Haves

Data Analysis and Reporting: Skills in collecting, analyzing, and reporting data to track program outcomes and meet NC Medicaid reporting requirements.
Familiarity with Electronic Health Records systems. Although we have already selected Ritten as our EHR, the consultant should be proficient with and able to advise on how it can best integrate with workflows, billing, reporting, and data management.
HIPAA and HITECH expertise to ensure that what is being set up is fully compliant.
Health Care Billing including 835 and 837 EDI files. The consultant should help establish efficient billing processes for NC Medicaid mental health services. They should guide in implementing and managing 837 electronic claim submissions and 835 electronic remittance files. The consultant should help develop procedures for "scrubbing" claims before submission to ensure accuracy and reduce claim denials. They should also assist in developing a system for managing claim denials and appeals.

Responsibilities

Conduct an in-depth assessment to strengthen World Relief's capacity and program quality.
Collaborate with stakeholders to define specific goals and priority areas, assess the organization's viability for Medicaid managed care integration, and draft a detailed timeline and phased implementation plan.
Identify and collaborate with key stakeholders (e.g. NC Medicaid, Alliance Health).
Draft a strategic plan tailored to the specific needs of the organization, outlining goals, priority areas, and a phased implementation timeline.
Conduct a thorough review of contracts, job descriptions, policies, procedures, workflow processes, communication structures, IT systems, reporting mechanisms, program management, billing procedures, and specialty services.
Provide holistic training for staff in critical areas such as workflow assessment, communication, IT systems, reporting, program management, and billing to ensure compliance and best practices.
Lead the collaboration with stakeholders to identify goals and priority areas.
Conduct analysis to assess World Reliefâs current capacity and benchmarks to meet.
Develop a detailed timeline and phased implementation plan.
Craft a project schedule that outlines tasks, dependencies, and milestones to ensure a structured approach to the implementation process.
Provide comprehensive oversight from inception to conclusion.
Develop a detailed project plan delineating tasks, timelines, and resource allocation.
Support the review of contracts, job descriptions, policies, and procedures.
Collect and analyze data