C/S Health Care Cost Containment Specialist

About the role

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.

Essential functions

• 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.
• Collates 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.

JOB REQUIREMENTS for Health Care Cost Containment Specialist

• 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.

Pay and Benefits

This is a Casual/Seasonal position which is a non-pension eligible position without healthcare and/or other benefits.

Application Instructions

To apply, fill out the Supplemental Questionnaire and Application NOW using the Internet. Alternatively, upload your resume to start an application. For further assistance, you may contact us by phone at (302) 739-5458, or e-mail at jobs@delaware.gov.