Medicaid Insurance Experience Software Experience Data Exchange Developer (Jobs   Requirement id 61270 Job title Developer Job location in Bismarck, ND Skills required Medicaid, Project Management Experience, Data Entry, Insurance Experience Software Experience Open Date 25-May-2017 Close Date Job type Not specified Duration 23 Months Compensation DOE Status requirement --- Job interview type ---    Email Recruiter: coolsoft Job Description Developer: Medicaid, Project Management Experience, Data Entry, Insurance Experience Software Experience Start Date : 08/01/2017 End Date : 06/30/2017 Submission Deadline : 06/28/2017 Description : Title: Medicaid Recovery Audit Contractor (RAC) Services A. Project Manager: the successful offeror must hire a Project Manager (a designated key staff person) to liaise between the successful offeror and STATE. The Project Manager must have the following minimum qualifications: 1. Three years experience in the management and administration of utilization review projects; 2. Three years experience in working with Medicaid and Medicare policies and procedures or three years experience in working with private and commercial insurance company policies and benefits; 3. Three years experience in the use of computer programs and software, data entry, data exchange, database creation, claims processing, spreadsheet creation, templates, and reporting functions; 4. Three years experience working with an appeals process; and 5. Working knowledge of medical terminology and legal terminology. B. Medical Director: the successful offeror must employ or contract with a medical director and arrange for an alternate when the medical director is unavailable for extended periods. The medical director must be either a Doctor of Medicine or a Doctor of Osteopathy who has relevant work and educational experience and licensed by the state of North Dakota (a North Dakota issued Administrative license is acceptable). The medical director must have the following work experience and education: 1. Relevant work experience: a. Prior work experience in the health insurance industry, utilization review firm, or health care claims processing organization; b. Extensive knowledge of healthcare programs (public or private), particularly the coverage and payment rules; and c. Public relations experience, such as working with physician groups or beneficiary organizations. 2. Educational Experience in practicing medicine as a board certified doctor or doctor who is currently licensed. All clinicians employed or retained as consultants must be currently licensed to practice medicine in the state of North Dakota, and successful offeror must periodically verify that their license is current. When recruiting the medical director, successful offeror must give preference to physicians who have patient care experience and are actively involved in the practice of medicine. The medical directors duties relevant to the RAC are listed below. Primary duties include: a. Providing the clinical expertise and judgment to understand North Dakota Medicaid policy; b. Serving as a readily available source of medical information to provide guidance in questionable claims audit situations; c. Recommending when provider education, system edits, or other corrective actions are needed or must be revised to address RAC vulnerabilities; d. Keeping abreast of medical practice and technology changes that may result in improper billing or program abuse; and e. Participating in the second level of appeals process in instances where a medical determination is needed. To prevent conflict of interest issues, the successful offeror must provide written notification to STATE within ten days after the appointment, election, or membership effective date if the medical director becomes a committee member or is appointed or elected as an officer in any state or national medical societies or other professional organizations. In addition, medical directors who are currently in practice should notify STATE of the type and extent of the practice.   Call 502-379-4456 Ext 100 for more details. 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