Suggested Staff Positions. The Contractor is responsible for ensuring adequate staffing to meet the requirements of the Contract and the delivery of high quality, operationally efficient services. FSSA may require additional staffing for Contractors who fail to maintain compliance with the performance metrics of the Contract. Suggested staffing includes, but is not limited to those listed below. Respondents shall describe its staffing plan in the RFP response. Executive management to interface with FSSA leadership to coordinate and confer with the State on matters related to the Contractor’s participation in the Hoosier Care Connect program. Technical support services staff to ensure the timely and efficient maintenance of information technology support services, production of reports and processing of data requests and submission of encounter data. Quality management staff dedicated to perform quality management and improvement activities, and participate in the Contractor’s internal Quality Management and Improvement Committee. Utilization and medical management staff dedicated to perform utilization management and review activities. Member services representatives to coordinate communications between the Contractor and its members, respond to member inquiries, and assist all members regarding issues such as the Contractor’s policies, procedures, general operations, benefit coverage and eligibility. Member services staff should have access to real time data on members, including, but not limited to, eligibility status and all service and utilization data. Member services staff must have the appropriate training and demonstrate full competency before interacting with members. Member marketing and outreach staff to manage marketing and outreach efforts for the Hoosier Care Connect program. Compliance staff to support the Compliance Officer and help ensure all Contractor functions are in compliance with state and federal laws and regulations, the State’s policies and procedures and the terms of the Contract. Provider representatives to develop the Contractor’s network and coordinate communications between the Contractor and contracted and non-contracted providers. Claims processors to process electronic and paper claims in a timely and accurate manner, process claims correction letters, process claims resubmissions and address overall disposition of all claims for the Contractor, per state and federal guidelines. A sufficient number of staff to ensure the submissi...
Suggested Staff Positions. The Contractor is responsible for ensuring adequate staffing to meet the requirements of the Contract and the delivery of high quality, operationally efficient services. FSSA may set required staffing levels for contractors. FSAA may require additional staffing for Contractors who fail to maintain compliance with the performance metrics of the Contract. Suggested staffing includes, but is not limited to those listed below. The Contractor shall adhere to the State approved staffing plan.
Suggested Staff Positions. The Contractor is responsible for ensuring adequate staffing to meet the requirements of the Contract and the delivery of high quality, operationally efficient services. FSSA may set required staffing levels for contractors. FSAA may require additional staffing for Contractors who fail to maintain compliance with the performance metrics of the Contract. Suggested staffing includes, but is not limited to those listed below. The Contractor shall adhere to the State approved staffing plan. • Executive management to interface with FSSA leadership to coordinate and confer with the State on matters related to the Contractor’s participation in the Hoosier Care Connect program. • Technical support services staff to ensure the timely and efficient maintenance of information technology support services, production of reports and processing of data requests and submission of encounter data. • Quality management staff dedicated to perform quality management and improvement activities, and participate in the Contractor’s internal Quality Management and Improvement Committee. • Utilization and medical management staff dedicated to perform utilization management and review activities. • Member services representatives to coordinate communications between the Contractor and its members, respond to member inquiries, and assist all
Suggested Staff Positions. The Contractor is responsible for ensuring adequate staffing to meet the requirements of the Contract and the delivery of high quality, operationally efficient services. FSSA may set required staffing levels for contractors. FSAA may require additional staffing for Contractors who fail to maintain compliance with the performance metrics of the Contract. Suggested staffing includes, but is not limited to those listed below. The Contractor shall adhere to the State approved staffing plan. ▪ Executive management to interface with FSSA leadership to coordinate and confer with the State on matters related to the Contractor’s participation in the Hoosier Healthwise program. ▪ Technical support services staff to ensure the timely and efficient maintenance of information technology support services, production of reports and processing of data requests and submission of encounter data. ▪ Quality management staff dedicated to perform quality management and improvement activities, and participate in the Contractor’s internal Quality Management and Improvement Committee. ▪ Utilization and medical management staff dedicated to perform utilization management and review activities. ▪ Member services representatives to coordinate communications between the Contractor and its members, respond to member inquiries, and assist all members regarding issues such as the Contractor’s policies, procedures, general operations, benefit coverage and eligibility. Member services staff should have access to real time data on members, including, but not limited to, eligibility status and all service and utilization data. Member services staff must have the appropriate training and demonstrate full competency before interacting with members. ▪ Member marketing and outreach staff to manage marketing and outreac h efforts for the Hoosier Healthwise program. ▪ Compliance staff to support the Compliance Officer and help ensure all Contractor functions are in compliance with state and federal laws and regulations, the State’s policies and procedures and the terms of the Contract.
