Healthcare Cost Containment Strategist

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

Introduction

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.

For more information, please visit (Use the "Apply for this Job" box below). today!

Summary Statement

The incumbent in this position will assist Community Health Clinics in all three counties with insurance credentialing and provider enrollment activities in collaboration with administrative staff and insurance companies. The position reviews insurance claim denials in correlation with client electronic medical record (EMR) documentation to identify discrepancies, support reimbursement, and improve claims resolution. Maintains records, communicates with insurance carriers, and supports operational efficiency through coordination and adherence to clinic processes and procedures.

Essential Functions

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

• Serves as Department's technical expert in the highly complex areas of health care cost containment.
• Manages, directs and/or performs specialized studies which result in alternative health care delivery systems and methodologies. Supervises staff as needed when directing any project.
• Provides technical expertise to other Divisions, within the Department, in the areas of policy development, research and evaluation, reimbursement methodologies and health care cost containment initiative.
• Collects and analyzes varied and complex data used in support of report, project and funding development purposes.
• Serves on or coordinates special committees, task forces, and working groups involved in strategic planning, policy development, service delivery and cost containment projects for the Department.
• Analyzes reports and documents from federal, state and the department and recommends cost containment policy changes.
• Prepares annual legislative Health Care Cost Containment Report which outlines the Department activities in this area.
• Keeps abreast of legislative and technical developments and change related to the area.
• Works with other state, local or private agencies that are affected by cost containment policy changes

• Three years experience in health care cost containment such as analyzing health care costs and recommending delivery systems and reimbursement procedures.
• Six months experience in developing policies and procedures.
• Six months experience in interpreting health care laws, rules, regulations, standards, policies and procedures.
• Six months experience in health or human services program administration such as overseeing and directing the development, implementation and evaluation of health or human services programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
• Knowledge of managing budgets, grants or contracts.
• Knowledge of staff…