Notice ID: 250239
The following knowledge and experience are required:
- Knowledge of the NSA, Mental Health Parity Addition and Equity Act (MHPAEA), and other Federal laws and programs related to billing disputes and alleged violations of the Public Health Service Act (PHS Act);
- Knowledge of Federal rules and regulations applicable to Federal contractors/covered entities, including Health Insurance Portability and Accountability Act (HIPAA) data transmission, data security, privacy, the Federal Information Security Management Act (FISMA), the Privacy Act, and 508 compliances.
- Experience with the intake of inquiries and complaints via multiple methods (i.e. telephone services, web-based submissions)
- Experience with providing a multi-tiered help desk to receive and respond to complaints and inquiries.
- Experience and expertise with Salesforce or a similar Customer Relationship Management (CRM) technology.
- Experience in working with existing system solutions and external systems through application program interfaces (APIs) and supporting User Acceptance Testing (UAT) processes.
- Experience with the development of protocols for reviewing and identifying basic and complex inquiries and complaints.
- Experience with conducting reviews of basic and complex inquiries and complaints involving health insurance plans and issuers, and medical services.
- Experience with the referral of inquiries and complaints under the enforcement authority and/or jurisdiction of other state or federal resolution processes.
- Experience with developing and following ticketing and tracking protocols.
- Experience with collecting data regarding the types of inquiries and complaints received.
- Experience with providing technical assistance to the public regarding complex processes and state and/or federal requirements.
- Experience with maintaining and adhering to a schedule in order to manage multiple competing tasks.
- Experience in effective project management.
- Thorough understanding of HIPAA requirements and Protected Health Information (PHI) rules and regulations.
- Ability to produce ad hoc reports in response to CMS inquiries and deadlines.
- Prior experience performing multiple process changes under tight timeframes.
- Experience in working with large amounts of data in various file formats and securely transferring files to Federal and State Agencies, and their contractors.
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