Specialist Member Research

Description SCOPE OF POSITION: Provide communication, education and promotion of the program services. Have a clear understanding of contract deliverables and collaborate with other professional staff to meet the contract deliverables within designated timeframes. Responsible for identifying problems or issues with beneficiary records, researching the cause of an issue and correcting by updating the beneficiary’s records to support the correction by linking beneficiary records within the appropriate system to correct system errors. Serve as a subject matter expert and trainer for CURAM and MMIS. Responsible for collaborating with MMCS staff regarding beneficiaries and medical providers, ensuring timely provision of services and, responsible for providing appropriate follow-up and documentation of services rendered in the system designated by AFMC’s IT department, DHS and DXC. Must have knowledge of all technical software required to complete the processes and to appropriately complete the requirements of the contract deliverables. Support the initiative to improve and ensure improvements in quality of research methodology. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork.

Essential Job Functions

• Onsite presence may be required at DHS and AFMC.
• Assist in the development of schedules for projects taking into consideration contract deliverables, member needs, department workload, resource/capacity constraints and vendor capabilities.
• Assist in the management of timelines and approaching deliverable dates including contract deliverables, quality indicators, data collection, conferences, educational sessions, publication deadlines, special functions, etc. to ensure that deadlines are met, as directed.
• Assist in the coordination and development of tools in collaboration with the project team and communications for providers and consumers about project goals.
• Serve as back up for other support staff as required.
• Assist with incoming members requests for information. Research issues and determine the appropriate party or course of action to address the request for resolution. Maintain a database of all calls received and actions taken.
• Understand and utilize project-tracking software for reporting purposes. Perform data entry into both internal and/or external program databases.
• Daily quotas may be added to meet contract deliverables as needed.
• As required, compose, edit and assist in creating communications and/or materials for projects.
• Communicate effectively with all internal and external customers.
• Assist with organization, coordination and support of workgroup meetings, workshops, seminars, periodic outreach presentations and educational programs to facilitate the health care community’s participation in research projects.
• Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
• Perform data entry, organize, file and maintain departmental records, manuals and correspondence.
• Maintain a general working knowledge of department / contract deliverables.
• Assist in the review, verification, testing and editing of work produced by other staff members as directed.
• Additional duties as assigned.

Knowledge, Skills And Abilities

• Intermediate skill level with MS Office (Excel, Word, PowerPoint, and Outlook).
• Type 25 wpm.
• Strong skills in business English and spelling.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Ability to train existing or new staff members
• Creativity and flexibility.
• Ability to meet deadlines.
• Attention to detail.
• Medical terminology.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients and the public.
• Ability to multitask.
• Ability to prioritize.
• Strong organizational and problem-solving skills.
• Professionalism.
• Ability to read, interpret and apply laws, rules and regulations.
• Time management skills.
• Regular and punctual attendance.
• Ability to work overtime as needed.

Requirements Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices): Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to lift and transport 30 pounds. Must be capable of performing the essential functions of this job, with or without reasonable accommodations.

Education : High School Diploma

Desirable: Associate degree or additional education

Experience : Two (2) years of Medicaid experience. One (1) year of research experience.

Desirable: Prior experience with Medicaid Systems (MMIS, Curam, and Answer). Prior Medicaid billing experience.

Internet Requirements Reliable, high-speed wireless internet service (Wi-Fi)

An upload speed of at least 5Mbps is required to support softphone functionality.