Talent.com
NC Medicaid Consultant
NC Medicaid ConsultantWorld Relief • Durham, NC, US
NC Medicaid Consultant

NC Medicaid Consultant

World Relief • Durham, NC, US
30+ days ago
Job type
  • Full-time
Job description

NC Medicaid Consultant

Are you a person of compassion? An advocate for justice? Someone who stands up for the rights of the vulnerable and speaks out for the marginalized, the exploited and the forgotten? Do you believe in our calling as Christians to welcome the least of these and love our neighbor?

If you answered 'yes', to any of the above, World Relief, and millions of people around the world need you.

At this pivotal moment in time, we are rapidly expanding and growing our team to meet the increasing needs of our world. We are looking for people who want to use their gifts and talents to make a real and tangible difference in our world and the lives of the suffering.

If you're looking for a purpose-driven career in which you can grow your talents, while also standing up for the rights of the vulnerable, we want you to join us today.

ORGANIZATION SUMMARY :

World Relief is a global Christian humanitarian organization whose mission is to boldly engage the world's 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.

POSITION SUMMARY :

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.

Responsibilities :

  • The ideal scope of work to include :
  • 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. Proposed tasks to include :
  • Lead the collaboration with stakeholders to identify goals and priority areas.
  • Conduct analysis to assess World Relief's 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

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).
  • Preferred Qualifications :

  • 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.
  • Create a job alert for this search

    Consultant • Durham, NC, US

    Related jobs
    Local Contract MRI Technologist

    Local Contract MRI Technologist

    Host Healthcare • Chapel Hill, NC, US
    Full-time
    Host Healthcare is seeking a local contract MRI Technologist for a local contract job in Chapel Hill, North Carolina.Job Description & Requirements. Pay package is based on 12 hour shifts and 36...Show more
    Last updated: 30+ days ago • Promoted
    Consulting Actuary - Medicare Risk Adjustment

    Consulting Actuary - Medicare Risk Adjustment

    Blue Cross and Blue Shield of North Carolina • Chapel Hill, NC, United States
    Full-time
    As a Consulting Actuary at our healthcare organization, you will play a pivotal role in shaping the future of care delivery through data-driven insights and strategic actuarial expertise.You'll lea...Show more
    Last updated: 30+ days ago • Promoted
    Local Contract MRI Technologist - $51-55 per hour

    Local Contract MRI Technologist - $51-55 per hour

    Host Healthcare • Chapel Hill, NC, United States
    Full-time
    Host Healthcare is seeking a local contract MRI Technologist for a local contract job in Chapel Hill, North Carolina.Job Description & Requirements. Host Healthcare Job ID #La1fVJ000007pN09YAE.Pay p...Show more
    Last updated: 30+ days ago • Promoted
    Sales Consultant - Chapel Hill, NC

    Sales Consultant - Chapel Hill, NC

    Winebow • Chapel Hill, NC, US
    Full-time
    Sales Consultant - Chapel Hill, NC.At Winebow, we are strongly committed to creating an environment that fosters diversity, equity, and inclusion. We are intentional in our efforts to ensure that ev...Show more
    Last updated: 30+ days ago • Promoted
    Local Contract CT Technologist

    Local Contract CT Technologist

    Medical Solutions Allied • Roxboro, NC, US
    Full-time
    Medical Solutions Allied is seeking a local contract CT Technologist for a local contract job in Roxboro, North Carolina. Job Description & Requirements.We’re seeking talented healthcare p...Show more
    Last updated: 7 days ago • Promoted
    Local Contract CT Technologist

    Local Contract CT Technologist

    Host Healthcare • Roxboro, NC, US
    Full-time
    Host Healthcare is seeking a local contract CT Technologist for a local contract job in Roxboro, North Carolina.Job Description & Requirements. Pay package is based on 12 hour shifts and 36 hour...Show more
    Last updated: 30+ days ago • Promoted
    Travel Nurse RN - ED - Emergency Department

    Travel Nurse RN - ED - Emergency Department

    AHS Staffing • Roxboro, NC, US
    Full-time
    AHS Staffing is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Roxboro, North Carolina.Job Description & Requirements. Pay package is based on 12 hour shifts and...Show more
    Last updated: 8 days ago • Promoted
    Home Care & Hospice Licensing & Applications Consultant (1099 Contractor)

    Home Care & Hospice Licensing & Applications Consultant (1099 Contractor)

    Traditions Health • Durham, NC, US
    Full-time
    Home Care & Hospice Licensing & Applications Consultant.The Home Care & Hospice Licensing & Applications Consultant (1099 Contractor) has the primary responsibility to advise and assist client agen...Show more
    Last updated: 20 days ago • Promoted
    Local Contract Travel Emergency Department RN

    Local Contract Travel Emergency Department RN

    Stability Healthcare • Roxboro, NC, US
    Full-time
    Stability Healthcare is seeking a local contract nurse RN ED - Emergency Department for a local contract nursing job in Roxboro, North Carolina. Job Description & Requirements.Stability Healthca...Show more
    Last updated: 21 hours ago • Promoted • New!
    Business Consultant Unique III

    Business Consultant Unique III

    Katalyst Healthcares & Life Sciences • Durham, NC, US
    Full-time
    Value & Access Analytics & Operations Contractor.We are seeking a highly skilled and detail-oriented Value & Access (V&A) Analytics & Operations contractor to join the Value & Access team within Me...Show more
    Last updated: 30+ days ago • Promoted
    Subject Matter Expert Medicaid Program Integrity, Policy, Systems, and Claims Audits

    Subject Matter Expert Medicaid Program Integrity, Policy, Systems, and Claims Audits

    BerryDunn • Durham, NC, US
    Full-time
    Medicaid Practice Group Consultant.BerryDunn's Medicaid Practice Group, with headquarters in Portland, Maine, focuses nationally on serving the organizational, program, information technology, and ...Show more
    Last updated: 20 days ago • Promoted
    Correctional Medicine Physician

    Correctional Medicine Physician

    MSI Systems Corp, DBA Medical Search International • Not Specified, NC, USA
    Full-time
    North Carolina (40 mins east of.Internal Medicine / Family Medicine / Urgent Care / Primary Care.NC license, Active DEA, Board Certified / Eligible in related specialty. Travel, lodging (if needed), a...Show more
    Last updated: 30+ days ago • Promoted
    Travel Emergency Department RN

    Travel Emergency Department RN

    ARMStaffing • Roxboro, NC, US
    Full-time
    ARMStaffing is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Roxboro, North Carolina.Job Description & Requirements. Emergency Department Registered Nurse\n\n.T...Show more
    Last updated: 30+ days ago • Promoted
    Local Contract Travel Emergency Department RN

    Local Contract Travel Emergency Department RN

    Host Healthcare • Roxboro, NC, US
    Full-time
    Host Healthcare is seeking a local contract nurse RN ED - Emergency Department for a local contract nursing job in Roxboro, North Carolina. Job Description & Requirements.Pay package is based on...Show more
    Last updated: 8 days ago • Promoted
    Travel Emergency Department RN

    Travel Emergency Department RN

    GHR Healthcare - Travel Division • Roxboro, NC, US
    Full-time
    GHR Healthcare - Travel Division is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Roxboro, North Carolina. Job Description & Requirements.GHR Healthcare - Trave...Show more
    Last updated: 30+ days ago • Promoted
    Correctional Medicine Physician

    Correctional Medicine Physician

    RCM Health Care Services • Not Specified, NC, USA
    Full-time
    Correctional Medicine Physician at RCM Health Care Services summary : .A Correctional Medicine Physician is needed for a full-time position in a North Carolina correctional facility.The role involves...Show more
    Last updated: 30+ days ago • Promoted
    Local Contract Med / Surg Telemetry RN

    Local Contract Med / Surg Telemetry RN

    Host Healthcare • Roxboro, NC, US
    Full-time
    Host Healthcare is seeking a local contract nurse RN Med Surg for a local contract nursing job in Roxboro, North Carolina. Job Description & Requirements.Pay package is based on 12 hour shifts a...Show more
    Last updated: 8 days ago • Promoted
    Travel Emergency Department RN

    Travel Emergency Department RN

    Uniti Med • Roxboro, NC, US
    Full-time
    Uniti Med is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Roxboro, North Carolina.Job Description & Requirements. Cigna medical, MetLife dental and vision insu...Show more
    Last updated: 11 days ago • Promoted