State Of Illinois Work Values

Daily Duties at State Of Illinois:

• Manage all aspects of complex Medicaid regulatory and compliance audits and medical quality peer reviews; Evaluate preliminary findings and provide legal, analytical, and strategic direction to auditors and nurses to ensure accuracy and sufficiency of determinations pertaining to state and federal health care laws, rules, regulations, and policies, as well as ICD-9, CPT, and HCPCS coding; Direct audits and peer reviews through timely completion • Investigate and analyze provider disclosures, billing trends, and prescribing patterns for high-risk activities; Provide senior management with legal opinions and recommendations on policy and legislative changes to eliminate Medicaid loopholes, reduce risk of issuing erroneous payments, and define potential cost savings; Coordinate with federal and state fraud investigators to assist with identification, prevention, detection, and elimination of fraud, waste, abuse, misconduct, and mismanagement in the Medicaid and Medicare programs • Draft Requests for Proposals, score submissions, and review contracts to verify accuracy prior to execution; Formulate and execute audit plan for substantiating propriety of EHR incentive payments made to providers • Represent the Bureau in discussions with health care providers about compliance audits, quality of care reviews, and the administrative litigation process; Educate providers on creation, maintenance, and retention of complete and proper records, policy interpretation, proper billing procedures, and reimbursement of overpayments; Recommend and draft settlement agreements and corrective action plans to ensure continued provider compliance • Develop and implement new audit protocols to improve program integrity and maximize productivity, resulting in a 400 percent increase in audits completed, and a 250 percent increase in identified overpayments • Provide guidance, mentorship, and managerial oversight; determine goals, objectives, and training needs; and develop and deliver training sessions for a 40-person team

What they like about State Of Illinois:

You highly value a work environment built on a formal structure, rules, and regulations. You do not enjoy the unpredictability of shifting priorities and deadlines that upset your routine. You require and enjoy direction, input and accountability as part of your work environment. You have a strong need to participate in making key decisions and feel left out if your superiors or co-workers do not seek your input when making decisions. You thrive on providing good customer service to both internal or external customers, and doing so makes you feel good.

Tags

Medicaid, Regulatory Compliance, Health Law, Legal Research, Legal Writing, Administrative Law, Microsoft Office

Skills

P&L responsibilities, Technology Solutions, Sales Support, Software Implementation, Requirements Analysis & Specification, Leadership

These are some of the questions we asked our climbers about their experiences with State Of Illinois: