Benefits Quality Control Manager 2025-02443

Job Title : Provider And Benefit Management Administrator

Employer : State of Wyoming

Salary : $6,171.35 Monthly

Location : Cheyenne, WY

Job Type : Permanent Full-time

Job Number : 2025-02443

Department : Department of Health

Division : Cheyenne and County Offices

Opening Date : 10 / 03 / 2025

Closing Date : Continuous

FLSA : Exempt

Job Classification : HSHP10

Description and Functions

Open Until Filled

General Description : Manages and oversees provider and benefit management functions for approximately one-third of Wyoming's statewide Medicaid program. Oversight includes provider coverage and billing policies, reimbursement methodology, claims payments and provider services monitoring, expenditure management and communication for a program that comprehensively pays over $500 million annually. Successful management and oversight will require ongoing collaboration between the Division of Healthcare Financing and the Centers for Medicare and Medicaid (CMS).

Human Resource Contact : wdhrecruit@wyo.gov

Essential Functions :

The listed functions are illustrative only and are not intended to describe every function which may be performed in the job level.

• Draft and implement program State Plan Amendments (SPA), rules, and policies governing coverage and reimbursement of the following provider / service types : Dentists, Immunizations, Hospital providers, including Psychiatric, Critical Access, Ambulatory Surgical Care, Diagnosis-Related Groups for hospital payments (DRG), Hospital Outpatient Prospective Payment System (OPPS), and Rehabilitation Hospitals.
• Serve as the Wyoming Medicaid subject matter expert and contact person for benefit and reimbursement questions related to the following provider types / services : Dentists, Immunizations, Hospital providers including Psychiatric, Critical Access, Ambulatory Surgical Care, Diagnosis-Related grouper for hospital payments (DRG), Hospital Outpatient Prospective Payment System (OPPS), and Rehabilitation Hospitals.
• Participate in and lead medical and dental association meetings, national meetings / trainings, representing Wyoming Medicaid. Attend weekly / monthly / quarterly meetings with other Medicaid programs and Agencies within the federal government and providers.
• Plan, implement, monitor, and evaluate program performance, goals, and objectives for the Department's larger performance management program.
• Provide ongoing contract management for the Orthodontic review contract.

Qualifications

Preferences :

The training and experience equivalent to a bachelor's degree in public administration, business, accounting, healthcare administration, political science or other closely related field with three years of professional work experience in business, accounting, political science, healthcare or public administration.

Knowledge :

Minimum Qualifications :

Education :

Bachelor's Degree (typically in Healthcare)

Experience :

1-2 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist

OR

Education & Experience Substitution :

4-6 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist

Certificates, Licenses, Registrations :

None

Necessary Special Requirements

Physical Working Conditions :

Notes :

Supplemental Information

Click here to view the State of Wyoming Classification and Pay Structure. URL : http : / / agency.governmentjobs.com / wyoming / default.cfm

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.