Medicaid Claims Manager

Kansas Department of Health and Environment; Kansas; Presencial; USD 41.000 - 45.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical/Dental/Vision

Leave Benefits

Holidays & Retirement

Descripción de la vacante

Kansas Department of Health and Environment is seeking a Supervisor for the Business Operations Team to oversee claims and encounter processing and maintain compliance with state and federal guidelines.

The role requires leadership experience, knowledge of Medicaid processes, and the ability to coordinate across departments to support operational efficiency.

Formación

• High School diploma or GED required.
• One year experience in health care government programs preferred.
• Strong data analysis and reporting skills desired.

Responsabilidades

• Supervise the Business Operations Team and oversee weekly status reporting.
• Mentor staff and conduct performance reviews.
• Coordinate with IT and fiscal teams on claims and encounters.

Conocimientos

Word processing

Excel

PowerPoint

Access

Educación

High School or GED

Bachelor’s Degree (preferred)

Herramientas

Microsoft Office

Data analysis tools

Descripción del empleo

Job Posting

Important Recruitment Information for this vacancy

Job Posting closes: October 18 th , 2026

Required documents uploaded by: October 18 th , 2026

Kansas Department of Health and Environment

Our agency is led by Secretary Janet Stanek, who was appointed by Gov. Kelly in Dec 2021. KDHE is comprised of three divisions: Public Health, Environment, and Health Care Finance (which includes the State’s Medicaid program, KanCare). We are the only agency in the nation to have these three entities under one roof which allows us to take a holistic approach to improving and protecting the health and well-being of all Kansans.

Verification of identity and employment eligibility to work in the United States is required by federal law. For a list of acceptable documents that establish these criteria, please refer to the federal Form I-9.

KDHE does not provide sponsorships for this position. If you are an OPT or STEM OPT applicant, please note that all individuals must maintain valid employment authorization and an unexpired EAD.

E-Verify: Kansas Department of Health and Environment (KDHE) participates in E-Verify and will provide the federal government with your I-9 information to confirm that you are authorized to work in the U.S. For additional information regarding E-Verify, please click here. For additional information regarding Immigrant and Employee Rights (IER) please click here.

http://www.kdhe.ks.gov/

About The Position

• Who can apply: Anyone (External).
• Classified/Unclassified Service: Unclassified
• Full-Time/Part-Time: Full-Time
• Regular/Temporary: Regular
• Work Schedule: Monday-Friday, 8am-5pm (Flexible schedules available)
• Eligible to Receive Benefits: Yes
• Veterans' Preference Eligible: Yes
• Sponsorship: KDHE does not provide sponsorship for this position.

Compensation

• Hourly Pay Range: $30.03 - $33.11
• Salary can vary depending upon education, experience, or qualifications.

Employment Benefits

• Comprehensive medical, mental, dental, vision, and additional coverage
• Sick & Vacation leave
• Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave
• Paid State Holidays (designated by the Governor annually)
• Fitness Centers in select locations
• Employee discounts with the STAR Program
• Retirement And Deferred Compensation Programs

Visit the Employee Benefits page for more information…

Position Summary & Responsibilities

Position Summary

The position (K0247913)

Supervisory

• Perform supervisory tasks for the Business Operations Team:
• Directly supervise the Business Operations Team.
• Prepare weekly status reports on team activities.
• Ensure that the performance review process is completed timely.
• Mentor and cross train staff in the unit.
• Monitor tasks to ensure issues and questions are being directed to the appropriate team.
• Meet weekly with the team to ensure they have current instructions and directions to do their job effectively.
• Monitor teamwork queues.
• Prioritize team tasks.
• Document internal processes.

Perform administrative tasks associated with supervisor duties, such as:

• Monitor employee’s attendance,
• Timecard review/approval weekly,
• Employee mentoring,
• Training and development,
• Conduct mid-year and Annual performance reviews, and Annual position description reviews.

Provide Subject Matter Expertise to support Business Operations

• Provides interpretation of State and Federal guidelines regarding claim and encounter data processing.
• Contribute to the implementation of policy modifications affecting claims payment and encounter data processing.
• Provide support to the Provider and Managed Care Team by offering expertise on claims and encounter matters.
• Serve as subject matter expert and business lead for new projects or changes impacting claims and encounters.
• Demonstrate a comprehensive understanding of claims, claims edits, and the overall claims process.
• Possess a thorough knowledge of encounter components and the encounter process.
• Evaluaate proposed new processes to ensure alignment with business requirements and efficient implementation with minimal complexity.
• Review project deliverables for accuracy and completeness.
• Provide expert review and feedback on Requests for Proposal, contracts, or other agreements impacting claims and encounters.
• This includes providing operational requirements that MCOs, the fiscal agent, and other organizations must follow to meet state and federal requirements for claims and encounters.
• Facilitate the implementation of programs and system projects impacting claims and encounters by furnishing information, offering strategic guidance, and conducting necessary document reviews.
• Collaborate with IT system teams to resolve issues affecting claims and encounters.

Business Operations Oversight

• Implement and deploy quality performance standards and processes for monitoring requirements in claims processing and encounter data submissions.
• Monitor quality performance standards and contract compliance for claims and encounters, ensuring accurate, timely, and complete encounter data submissions.
• Direct fiscal agent activities regarding Business Operations initiatives, priorities, and issues.
• Evaluate and adjust operational practices, procedures, and activities to ensure team efficiency and focus on priority items.
• Participate in the implementation of policy changes affecting claims payment.
• Review all reports pertaining to claims and encounters that monitor the performance of the fiscal agent contractor and MCOs.
• Initiate corrective action as needed based on report reviews.
• Escalate high priority issues to senior manager
• Provide interpretation of guidelines regarding claim and encounter data processing.
• Assist the team and MCOs in coordinating activities with subcontractors.

Audits

• Participate in Annual State and Federal audits (up to 6 years) to analyze claims and encounter trends to reduce fraud, waste, and abuse. This includes participating in sessions, gathering and presenting information, responding to questions and addressing findings.
• Perform audits on the MCOs to ensure all claim and encounter policies for Kansas Medicaid are documented and correctly followed.

Communication

• Respond to written/verbal inquiries received from providers, contract agencies, internal staff, legislators, and beneficiaries.
• Work with Senior Manager on desired course of action in response to proposed legislation.
• Provide explanations, issues resolution, and general knowledge to internal and external customers

Financial Processes

• Implement and refine methodologies and processes for effective financial processing oversight.
• Collaborate with the Financial Processes Manager to ensure the timely and accurate management of accounts receivable, accounts payable, debt setoff, and legal referrals.
• Coordinate State and Contractor activities to optimize financial processes.
• Coordinate reporting efforts with the fiscal team to ensure the seamless receipt of all outstanding state funds.

Qualifications

• Education:
  • High School, GED
• Licensing & Certification:
  • Valid Driver's License - Incumbent is required to have and maintain a valid driver's license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State.
• Minimum Qualifications:
  • A total of Four years experience broken down into the following: One year of experience in a health care environment government programs such as Medicaid, Medicare, commercial insurance industry, or medical claims administration. One year of experience and knowledge in healthcare claims and billing. One year of experience in collecting, evaluating, studying or reporting on healthcare data. One year of supervisor experience required. Prefer familiarity with encounter data and 834 process and working with Managed Care Organizations.
  • Word, Excel, PowerPoint, Access
  • Proofreading, editing, attention to detail
  • Written and verbal communication skills
  • Staff management and supervisory experience
• Preferred Qualifications:
  • Bachelors Degree in any area of study
  • Analytical / troubleshooting skills
  • Familiarity with claims data and edits
  • Medical terminology and CPT/HCPCS/ICD10 code knowledge would be helpful.
  • Familiarity with encounter data and 834 process and working with Managed Care Organizations
  • Experience with leading business initiatives.
  • Supervisory work involving directive to analalize develop, implement and evaluate the team work
  • Experience in making quality improvement recommendations
  • Process improvement for internal and external team members
• Post-Offer, Pre-employment Requirements:
  • Kansas Tax Clearance Certificate: A valid Kansas Tax Clearance Certificate is a condition of employment for all employees of the State of Kansas. Applicants (including non-residents) who receive a formal job offer for a State job, are required to obtain a valid Tax Clearance within ten (10) days of the job offer. A Tax Clearance can be obtained through the Kansas Department of Revenue who reviews individual accounts for compliance with Kansas Tax Law. If you have a missing tax return(s) or you owe taxes to the State of Kansas, please know that the Kansas Department of Revenue will work with you. The Kansas Department of Revenue can set you up on a payment plan to receive a Tax Clearance so you can get a job working for the State of Kansas. The Kansas Department of Revenue can be contacted at 785-296-3199. Kansas Department of Revenue - Tax Clearance Frequently Asked Questions

The State of Kansas is an Equal Opportunity Employer. We value diversity, equity, and inclusion as essential elements that create and foster a welcoming workplace. All qualified persons will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, political affiliation, disability or any other factor unrelated to the essential functions of the job.

If you wish to identify yourself as a qualified person with a disability under the Americans with Disabilities Act and would like to request an accommodation, please address the request to the agency recruiter.