Medicaid Audit, Program Director

Position: Medicaid Audits, Program Director

Location: Mid-Atlantic

Work Requirements: Hybrid / In-person to client and industry events, as needed

Overview:

J29, Inc. has been supporting commercial, State, and Federal health and human service programs since company inception in 2017. Our team of 240 employees focuses on providing claim, policy, and clinical analysis on end-to-end medical cases, disputes, appeals, and audits. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.

J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that needs us most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.

J29’s Medicaid Audit, Program Director will focus on collaboration with the Centers for Medicare and Medicaid Services (CMS) to lead various types of program integrity focused reviews on States surrounding Managed Care compliance. This position will be responsible for management of J29’s Medicaid program, consisting of a team of six to ten employees focused on State audit and corrective action planning.

Role & Responsibilities:

The Program Director for J29’s Medicaid Program will be responsible for leading State-focused audits on Program Integrity compliance requirements, while ensuring that performance is conducted appropriately and that we are collaborating with respective States on lessons learned and areas they may improve. The ideal candidate will be aligned to our employee-centered culture, and fit into J29’s mission to empower our employees to do great things for the benefit of others.

·     Responsible for managing a small team of audit and review focused program integrity staff, and engaging with CMS directly to ensure performance is managed appropriately

·     Interact and oversee communication directly with State Medicaid agencies that are engaging with our team on audit reviews, or expected to engage with our team

·     Responsible to work internally to ensure audits are conducted appropriately, findings are documented and discussed appropriately, and lessons learned and shared with the respective State and CMS personnel

·     Forward thinking, data-driven, responsibility to ensure our team is bringing an innovative and improvement mindset to all State Medicaid agencies that we are engaging with on audits

·     Manage budget, deliverable, and contractual requirements with internal J29 management staff

·     Support and sit on the J29 Leadership Collaboration Group (LCG) team, with direct communication and collaboration with J29 senior leaders on a regular basis.

• Adhere to all corporate policies and processes, including timelines and milestones.
• Utilize highly persuasive communication skills for online facilitation, public speaking, and presentations.

Required Experience: 

• 10+ years of experience of experience in a professional/corporate healthcare environment, preferably with a Federal or State insurer such as Medicaid or Medicare
• 6+ years of experience directly supporting a State Medicaid agency, ideally in policy or compliance focuses
• 7+ years of experience in a management capacity with experience managing a team of five (5) or more employees with responsibility for managing complex systems and workflows as they relate to the healthcare ecosystem
• Ability to extract meaning from complex healthcare information and data where analysis and subject matter expertise need to be applied to generate outcomes.
• Sufficient Medicaid program and policy background with experience at the federal and/or state levels within the last ten (10) years;
• Strong experience using technical tools such as; Microsoft Office 365, SharePoint, Azure-based applications, and other Project Management tools.
• Extensive Medicaid program integrity subject-matter and analytics expertise, ideally including managed care, provider enrollment, or personal care program integrity or oversight experience
• Demonstrates a high degree of adaptability, comfortable in establishing new directions, managing rapid change, and trying different approaches to deal with uncharted territories.
• An advanced Medicaid program integrity background with oversight experience at the federal and/or state level;
• Possesses excellent interpersonal skills to build and maintain positive, productive relationships with peers, colleagues, managers, consultants, and clients.

EDUCATION & CERTIFICATIONS:

• Bachelor's degree in an applicable field, from an accredited institution, is required
• Master’s degree in Business Administration or Management, or Public Health or equivalent, is preferred.

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.