Program Manager – Electronic Visit Verification

Program Manager – Electronic Visit Verification

Requirements

• Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Responsibilities

• Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs.
• Works collaboratively with internal departments-Physical Health Utilization Management, Long Term Services and Supports Utilization Management, Claims, and Operations.
• Provides subject matter expertise in response to day-to-day external client facing business issues.
• Research applicable subject matter practices and remains aware of industry trends.
• Manages external client facing relationships and partners with corporate and regional business areas.
• Coordinates training related to external client facing program; develops program success measures and performs periodic assessments of program success.
• Collaborates with service coordination and provider relations teams to ensure compliance with EVV regulations.
• Monitors day-to-day EVV operations and supports issue resolution in collaboration with local IT Account Manager and Operations Lead.
• Monitors daily file performance, reviews EVV response files, and leads reconciliation of rejected authorization records from Vendor; this includes reviewing daily Healthy Blue fallout report to ensure errors are resolved and all authorizations are accounted for.
• Acts as Healthy Blue’s EVV Lead to external State Partners and Vendors, attending EVV Town Halls and other EVV-related State meetings to stay abreast on trends, upcoming changes, and provider concerns.

Preferred Qualifications

• Project management certification preferred.
• JIRA knowledge and experience is strongly preferred.
• FACETS knowledge and experience is strongly preferred.
• Managed Care organization experience is strongly preferred.
• Knowledge and experience in Kansas EVV system and understands what is needed to meet requirements is preferred.
• Understands how a claims system works in conjunction with the State of Kansas EVV Aggregator to support seamless claims adjudication preferred.
• Knowledge of standard billing practices and how to support providers with troubleshooting claims issues for EVV-required billing codes preferred.
• Comfortable with reviewing and trending EVV data from both internal sources as well as the State sponsored EVV aggregator preferred.