Claims Representative jobs at Indiana Farm Bureau

The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit our MDHHS Diversity, Equity, and Inclusion Plan. Medicaid Utilization Analyst 12 This position serves as the recognized resource to identify foster care individuals with psychotropic medication regimens that require additional physician review, preparing the physician review materials, and then performing additional monitoring or follow-up required following the physician review. Physician reviews are required for complex psychotropic medication cases as part of the Michigan Department of Health and Human Services Foster Care Psychotropic Medication Oversight (FC-PMOU) Section policy FOM 802-1 which was mandated as a result of a lawsuit settlement agreement. This position collaborates with the Foster Care - Psychotropic Medication Oversight steering committee across Department administrations (e.g., Health Services and Permancy and Wellbeing) and makes recommendations for improving psychotropic medication oversight and physician reviews. This position also works with various teams to re-design and implement the physician review process into the currently scheduled-to-be created CCWIS program replacing the MiSACWIS program. To identify psychotropic medication regimens that require additional physician review according to policy, the Utilization Reviewer actively monitors Medicaid claims data. Cases identified are prepared and assigned by the Utilization Reviewer to the MDHHS psychiatrist performing foster care psychotropic medication physician reviews. To maintain compliance with the lawsuit settlement agreement and policy requirements, the Department relies on the medical/pharmacological expertise in this position to prioritize high-risk cases for immediate review. This position collaborates with the FC-PMOU Outreach Analyst and Data Specialist to gather data, prepare utilization reports, and then develops and disseminates procedure and technical guidance information to MDHHS external customers/stakeholders as a result of the cases that have required Physician Review and follow-up. Position Description Job Specification To be considered for this position you must: * Apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted. * Relevant experience and/or education referred to in the supplemental questions must be documented in the resume, transcript and/or application to allow for accurate screening. * Attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week. * Attach a cover letter. * If applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts. Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature. Failure to complete any of the above items may result in your application not being considered. See instructions for attaching files here: Instructions Education Possession of a bachelor's degree in audiology, dental hygiene emergency medical technician, medical records administration, medical technology, nuclear medicine technology, nursing, occupational therapy, pharmacy, physician assistant, physical therapy, radiologic technology, rehabilitation, respiratory therapy, speech pathology, or sports medicine. Experience Medicaid Utilization Analyst 9 - No specific type or amount is required. Medicaid Utilization Analyst 10 - Two years of professional experience providing clinical patient care requiring documentation of services provided, patient progress, etc. (e.g. nursing/therapy services); or; one year of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst 9. Medicaid Utilization Analyst P11 - Four years of professional experience providing clinical patient care requiring documentation of services provided, patient progress, etc. (e.g. nursing/therapy services); or; two years of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst, including one year equivalent to a Medicaid Utilization Analyst 10. Medicaid Utilization Analyst 12 - Three years of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst, including one year equivalent to a Medicaid Utilization Analyst P11.Medicaid Utilization Analyst 9-12 Possession of a bachelor's degree in allied health, health education, health sciences, health care administration, chiropractic, health care management, health systems management, and health studies and licensure/certification in a clinical health care field may be substituted for the education requirement. Medicaid Utilization Analyst 12 Two years of experience as a Registered Nurse P11 or equivalent may be substituted for the education requirement. This position is being reposted. If you applied previously, there is no need to apply again. The physical location of this position is remote unless return to office requirement - 400 S Pine St, Lansing, MI. Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered. Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview. Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including: * A secure work location that allows privacy and prevents distractions. * A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload. * Suitable lighting, furniture, and utilities. The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises. As a Condition of Employment: this position requires successful completion of a background investigation and a criminal records check. The Department of Health & Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received. For information about this specific position, please email ***************************. Please reference the job posting number in subject line. Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration. Only those applicants interviewed will be notified of the results. If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required. Follow us on LinkedIn for more job opportunities! MDHHSJobs #MDHHSJobs #Veteranfriendly #CareersWithPurpose #CommunityHeroes MDHHS is proud to be a Michigan Veteran's Affairs Agency (MVAA) Gold Level Veteran-Friendly Employer