Medical Policy Manager / Customer Care Manager I – Cheyenne, Wyoming

Conduent is the world’s largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve. We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry.

We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world. Whether it’s digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning – Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com . If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.

State HealthCare Wyoming Medicaid Fiscal Agent Operations JOB Description Position: Medical Policy Department Medical Policy Manager Description: The Medical Policy Manager is responsible for the managing, initiating, and implementing Wyoming Medicaid medical policy as directed by the state. They are responsible for prior authorizations, program integrity, medical reviews, and managing MMIS subsystems and related tools pertaining to these functions. Major Position Responsibilities: Responsible for understanding, managing, implementing Wyoming Medicaid medical policy. Cost containment pertaining to medical policy Research, development, implementation, and application of medical policy issues.

Claims resolution requiring medical review. Maintain the procedure, drug, and diagnosis file and the related criteria within it. Develops and maintains prepayment utilization review criteria consistent with Wyoming Medicaid policy. Initial review of program integrity profiles and medical records.

Maintains SUR (Surveillance Utilization Review) functions (eg EFADS (Enterprise Fraud and Abuse Detection System) and DSS (Decision Support System) Recommend cost containment initiatives pertaining to medical policy. Responds timely and accurately to the State’s inquiries. Responsible for establishing and reevaluating departmental goals. Responsible for quality assurance of all the department’s functionalities.

Able to understand, utilize, and apply the CFR, Medicaid rules, State plan, etc. Answer provider, client and other agencies questions. Responsible for hiring, completing disciplinary actions and terminating staff. Coaches, trains, and develops team members.

Consults and advises the state on medical issues as requested. Works with other companies contracted by the state. Knowledgeable of the MMIS, DSS, Wyoming Medicaid Policy, Edits, Resolution Text, and other resources to support the department and State. Communicates effectively with other department managers.

Consistently administer the company’s policies and procedures. Monitors and establishes quality controls to verify contractual requirements are being met. Attends conferences pertaining to the responsibilities of the department. Understand CPT, HCPCS and diagnosis codes and their appropriate use.

Other duties as assigned. Required Qualifications: A minimum of 3 years of previous medical or healthcare experience. Utilization review or quality assurance experience. Minimum of 3 years in a supervisory position.

Excellent problem solving and analytical skills. Effective verbal and written communication skills. Excellent organizational skills and the ability to prioritize multiple tasks. Self motivated.

Ability to make decisions Preferred Qualifications: Experience with Health Insurance Experience with an MMIS system. Familiarity with durable medical equipment. Physician and/or hospital coding experience. Sensitivity of POSITION: Works with protected health information (PHI).

Has access to confidential personnel information. Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the “Submit” button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form .