Contracts and Grants
· Review provider contracts to ensure accuracy and compliance with organizational standards.
· Maintain knowledge of provider service authorization standards, offer the ability to interpret errors, and provide troubleshooting guidance to providers of service, Administrative Entities, and Supports Coordination Organizations.
· Review claim documentation submitted by providers to verify compliance with Office of Developmental Programs’ (ODP) regulations and requirements.
· Ability to audit and provide feedback to requestors during annual and ad hoc claims review requests.
Rate Setting
· Load and maintain provider rates for ODP in relevant systems.
· Maintain the lead role with IT vendors during fiscal year renewal of service contracts.
· Analyze provider financial expense reports to determine the appropriateness of an exceptional rate in relation to the approved fee schedule rates.
· Review and confirm cost report data specific to cost report-based rates.
Special Handling
· Serve as the liaison by communicating with providers to address questions and resolve issues.
· Compile information with critical detail, draft, and send formal correspondence to providers of service.
· Develop criteria and procedures for unique processes associated with rate setting.
· Analyze, recommend, and update current processes to align with changing factors and updated policies.
About Us:
TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.
TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com
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