Compliance Reporting and Claims/Encounter Support
Monitor and contract compliance reporting of all phases of the Medicaid fiscal agent’s operations. Provide claims/encounter research, technical assistance and issue resolution.
- Medicaid Fiscal Agent Contract Compliance Reporting
- Develop performance standards, report card items and performance measurement reporting tools. Review and approve scoring for monthly report cards. These standards are based on the requirements in the fiscal agent Medicaid Contract.
- Monitor Fiscal Agent Operations
- Daily evaluation of fiscal agent operations, including: researching issues reported by providers, area office staff and headquarters staff; reviewing the inventory and status of suspended claims; reviewing the inventory and status of claims in mailroom.
- Claims Support
- Provide research and technical support for claims inquiries and processing issues.
- Encounter Support
- Provide research and technical support for encounter inquiries and processing issues. Coordinate issues resolution through the Agency and the Fiscal Agent. Conduct encounter outreach and training workshops.