Government Informatics IT Consultant
- Phoenix, AZ
Mercer's Government Human Services Consulting (GHSC) practice focuses on the unique and challenging needs of the public health care sector, providing a wide array of consulting services to local, state and federal government agencies across the country. GHSC helps clients achieve better outcomes, develop and deploy defensible strategies and reshape the delivery of health care. We deliver an individualized focus, powered by industry-leading experience, integrated capabilities and passionate people. GHSC has been partnering with states and other stakeholder organizations for over 34 years to face the demands and pace of change with data-driven pricing, clinically-informed policy and trusted, reliable strategies to manage and deliver care.
To accomplish these challenging and exciting tasks, GHSC brings together a team of highly-skilled and dedicated consultants, clinicians, actuaries, analysts, accountants and pharmacists across four offices in Phoenix, Minneapolis, Atlanta and Washington DC, as well as via numerous remote "work-from-home" locals.
To learn more about Mercer's GHSC practice, please visit www.mercer-government.mercer.com.
To fulfill this role, the Government Informatics IT Consultant can expect to: be involved in projects with a focus on various claims systems, payment of claims and the collection of encounter data. A significant part of this role is to be a contributor on projects. Additional responsibilities include new and expanded business development and intellectual capital development. Level of support depends on the size of the client as well as the complexity of the services provided. At this level, the Government Informatics IT Consultant may work in conjunction with project teams, the Client Leader or on their own as the owner of client projects. Examples of projects/analyses the Government Informatics IT Consultant would be involved in include:
- Medicaid claims and encounter system reviews and implementations involving:
- Claims system assessments
- Ongoing monitoring of claims and encounter systems required by External Quality Review (EQR) regulations and/or state initiatives
- Reviews focused on the examination of eligibility, provider, claims and encounter data, policies and procedures, system security and disaster planning
- Procedures for eligibility and provider data sharing between managed care organizations (MCOs) and the state
- Analysis of business requirements for MCO encounter submissions
- Validating encounter data edits for submissions by MCOs
- Review of errors on encounter submissions for billing, claims processing or programming issues
- Develop reports for MCOs and state clients that summarize findings and recommendations, as well as, tools for monitoring encounter data
- Work with MCOs:
- Conduct MCO readiness reviews for developmental disabled populations, and medical and behavioral health organizations
- Perform reviews for compliance of MCO encounter data processes to documented state requirements for accuracy and completeness
- HIPAA transaction compliance
- Perform MCO Information System Capabilities Assessments (ISCA)
- Oversight of MCO efforts for improving encounter data
- Provide recommendations for improving data collection and claims processing using best practices
- Additional tasks:
- Oversee data analysis to calculate utilization and financial management reports including shadow pricing of encounters and categorization of services in financial reporting
- Perform encounter data validation for accuracy of data elements, payments and potential duplicates for multiple projects including EQR compliance activities, risk adjusted rates and rate setting activities
- Conduct research on the Centers for Medicare and Medicaid (CMS) and state-specific encounter data regulations and specifications
- Lead claims and information systems health care technical assistance projects including HIPAA, system procurements and system implementations
- Quantify data issues with claims, encounters, eligibility, provider contracts, fee schedules, vendor data, ancillary systems, reports, and provide recommendations for improvements in efficiency, completeness and accuracy of operational processes and data
More generally, Mercer Consultants will:
- Work with the Client Leader to manage the client, project, budget, resources, timelines, scope of work and expectations
- Manage the day-to-day relationship with the key members of the client team; individually or in conjunction with the Client Leader, presents on project results to clients, carriers, managed care entities, and other related entities
- Work with the Client Leader to initiate the project after a project is sold to the client. This includes meeting with the client and clearly defining the scope of work, timelines and deliverable of the project. Also develops and proposes essential project documents, including the budget and work plans
- Identify and secure resources, ensuring work is leveraged to the right skill and career level, and providing team members opportunity to develop skills and expertise; coordinate tasks with specialists on the project team, keeping the Client Leader informed on the project, ensuring regular team meetings and maintaining project documents; may produce documents stating project results, including reports, charts, analyses, etc.
- Project manage tasks on client deliverables in which a peer is the lead project manager; work with peers who are specialists to coordinate the specialist's contribution to the project
- Draft project communications
- Present results and analyses to clients and key stakeholders; during presentations, answers detailed and challenging questions regarding the data
- Be actively involved in the selling process with the Client Leader; contribute to the request for proposal (RFP) process; develop project approach and budgets; work with internal marketing team; write up RFP response
- Identify opportunities for expanded revenue with existing clients; utilize knowledge of client's challenges and of the diverse expertise within Mercer Government to identify sales opportunities
- Stay current on federal and relevant state health care information policies and regulations that impact client and client's programs
- Develop intellectual capital; lead or participate in the development of tools or processes that can be leveraged for multiple clients
To be considered for this opportunity, we require the following qualifications and experience:
- BA/BS degree or equivalent work experience
- Minimum five years of relevant experience required
- Working knowledge of claims systems and claim payment methodologies
- Familiarity with Medicaid managed care and health plan operations
- Excellent project management and interpersonal skills; strong oral and written communication skills
- Proficiency with MSOffice Suite (Word, Excel, and MS Access)
- Experience with electronic health record systems, Health Information Exchange, and/or Interoperability preferred
- Ability to prioritize and handle multiple tasks in a demanding work environment
- Strong critical thinking and analytical problem-solving skills
- Attention to detail
- Ability to work independently and on a team
- Ability to travel
The deep knowledge and experience of our people combined with winning strategies, creative ideas, tested innovation and industry recognized guidelines are why clients choose Mercer. This is our foundation, but our people bring everything to life, sharing their experience and knowledge to improve every outcome. Employees choose Mercer for career growth, as well as the opportunity to assist clients in providing efficient and innovative ways to deliver vital health care services. Projects include helping clients navigate the Affordable Care Act, program design for innovative models of health care, analyzing health care costs and trends, and assessing quality incentives and strategies to improve overall managed care program effectiveness. Mercer's stimulating and learning filled environment helps build strong relationships with colleagues and our clients.
Mercer GHSC is a specialty practice within Mercer's Health business. Mercer's Health business has the world's largest and most influential benefits brokerage and consulting capabilities. We strategize with clients of all sizes and industries to find benefits solutions that fit their needs. We provide the optimal combination of local-market knowledge and nationally-driven best practices. Our innovations translate into superior benefits for clients and distinguish Mercer in the marketplace.
Mercer GHSC is in a unique position to help our clients achieve the extraordinary - and extraordinary results require extraordinary people. If you thrive on challenge, are passionate about ideas, love solving problems and truly enjoy connecting with people, we encourage you to explore the career opportunities available through Mercer. Our competitive programs, entrepreneurial spirit and team-oriented culture offer a richly rewarding and exciting environment where you can excel and achieve your professional goals.
At Mercer, we make a difference in the lives of more than 110 million people every day by advancing their health, wealth, and careers. We're in the business of creating more secure and rewarding futures for our clients and their employees - whether we're designing affordable health plans, assuring income for retirement or aligning workers with workforce needs. Using analysis and insights as catalysts for change, we anticipate and understand the individual impact of business decisions, now and in the future. We see people's current and future needs through a lens of innovation, and our holistic view, specialized expertise, and deep analytical rigor underpin each and every idea and solution we offer. For more than 70 years, we've turned our insights into actions, enabling people around the globe to live, work, and retire well. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. At Mercer, we say we Make Tomorrow, Today. Visit www.mercer.com for more information and follow us on LinkedIn and Twitter @Mercer
Marsh & McLennan Companies offers competitive salaries and comprehensive benefits and programs including: health and welfare, tuition assistance, 401K, employee assistance program, domestic partnership benefits, career mobility, employee network groups, volunteer opportunities, and other programs. For more information about our company, please visit us at: http://www.mmc.com/. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. For more information, please visit us at: www.mmc.com/diversity.
Mercer LLC and its separately incorporated operating entities around the world are part of Marsh & McLennan Companies, a publicly held company (ticker symbol: MMC). Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.
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