Proven experience in applying structured methods such as Project Management Body of Knowledge (PMBOK) for the purpose of establishing and managing feasible project plans that are sufficiently resourced to achieve project goals, with project sponsorship, one interim milestone at a time.
Reimbursement methodologies such as National Average Drug Acquisition Cost (NADAC), Cost of Dispensing analysis, Hemophilia Factors reimbursement, and 340B Drug Programs to ensure compliance with federal legislation while maintaining beneficiary access to care.
Facilitating the advancement in maturity capability across the Medicaid enterprise including the development of MITA Roadmaps, completion of State Self-Assessments, Business Architecture and Process Management principles, and Information Architecture data models and governance.
Completes transition to the use of industry standards across trading partners and HIPAA Business Associates including electronic transactions formats with medical code set compliance, ICD-10 remediation efforts, HIPAA Privacy and Security Assessments, NCPDP and X12 standards sets in both state and county government settings.
Proven facilitation at integrating day-to-day child welfare worker operations and systems use with federal and state requirements including: client clearance processes and systems, intake and case management goals, temporary placements, application design and business rule documentation, data conversion, training, and statewide implementation.
Includes program knowledge and operational support including program administration, rate development, Medicaid Management Information Systems (MMIS) claims processing expertise, Fiscal Intermediary transition services, waiver services, federal compliance, state plan amendments, stakeholder outreach and procurement support.
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