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Completes all non-medical claims adjudication (Home health services, ALF, nursing Home) to include verifying claims and incidental charges, flags and researches questionable bills, prints remittance advice and check requests.
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As the Psychologist II, you will conduct forensic psychological evaluations and generate written reports on SVP residents, respondents under consideration for SVP commitment, and adult and adolescent inpatients and outpatients who are involved in the adjudication process or committed to the DMH forensic hospital.
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They must maintain knowledge of revenue cycle operations, third party reimbursement procedures & regulations, payer relations, claims adjudication, contractual claims processing, medical terminology, and an understanding of the 340B Drug Discount Program.
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Job hire is contingent upon applicant successfully completing and passing the adjudication and badging requirements for both Portland Public Schools and the HSPD-12 Tier-1 Security Credential. + Client background screening, fingerprinting, and security adjudication is a condition for employment and is required.
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Note: A Master's Degree or equivalent 36 credit hours of post baccalaureate course work from an accredited college or university in Educational Administration, Rehabilitation Counseling, Special Education, Counseling and Guidance, Vocational Evaluation, Psychology, or in a Social Science related field may be substituted for one year of the required experience in rehabilitation or in the adjudication or processing of disability claims.
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Must possess a current Top Secret (TS) clearance based upon a Single Scope Background Investigation (SSBI) completed within the past five (5) years and shall also be determined eligible for access to Special Compartmented Information (SCI) by the Central Adjudication Facility (CAF) or other designated adjudication authority prior to arrival onsite.
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Provide coverage in the Bell County Juvenile Services pre and post adjudication facilities when/as directed by the Area Manager or Department Administration. Monitors grievances and appeals for detention, post-adjudication facility, and the Juvenile Justice Alternative Education Program.
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O Experience working with eQIP, Personnel Security Databases such as Joint Personnel Adjudication System (JPAS), the Office of Personnel Management (OPM) Personnel Investigations Processing System (PIPS)/Central Verification System (CVS), Federal Personnel Payroll System (FPPS.
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Manage projects from initiation through closure for full scope regional and global projects, with activities focused on site selection, study start-up (including all systems and plan development), clinical operations, statistics and statistical programming, data management, subject randomization and drug supply management (IWRS), administration of data monitoring and/or adjudication committees, regulatory submissions, vendor management, and medical/scientific writing.
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In coordination with the Associate Dean of Students, the AVPDOS oversees the establishment and training of hearing panels, assures the adjudication of student code of conduct violations, and coordinates the Division of Student Affairs response to student emergencies.
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The Juvenile Prosecutor's duties include reviewing facts and circumstances of assigned cases to determine appropriate action (including diversion, informal adjustment, and adjudication). Work regularly with representatives from the Idaho Department of Health and Welfare, juvenile probation, local schools, early intervention specialists, counselors, the Department of Juvenile Corrections, and other agencies.
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Utilize experience with Applications in Claim Adjudication: RxClaim (PBM), Facets, Claim system, AEPPYS, CRS; QA Methodologies: SDLC waterfall model, Estimation, timeline and planning; QA Tools: HP - ALM, HP - UFT, Clear Quest, JIRA; iSeries and COBOL; Databases: DB2 and IDBMS; SOAP UI; Functional testing, Regression testing, Smoke testing, Automation testing; E2E testing; Managing and leading teams in Onsite - offshore model.
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In your lifetime have you ever had adjudication withheld, attended a pre-trial diversion program, drug court, served community service, or been given probation in lieu of criminal conviction? In the last 5 years have you been involved in any civil litigation (examples: divorce, child support, Bankruptcy, repossession, lien, contract dispute, eviction, contempt of court, etc.
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Manage design configuration including chairing the program design configuration control board (CCB) for engineering change including design integration and change adjudication with support from ESG engineering and ILS departments.
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This Level 5 (Moderate Risk; Public Trust) position requires favorable adjudication of a Minimum Background Investigation (MBI) background investigation prior to appointment, unless a waiver is obtained.
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adjudication job
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