Medicaid Program Specialist 3

Alaska Horizon; Anchorage (AK); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Free parking

Job summary

Alaska Department of Health is seeking a Medicaid Program Specialist 3 in Anchorage to support Medicaid claims processing and MMIS administration. Responsibilities include unit leadership, pricing and payment, service authorizations, NPI matching, and ensuring compliance with federal and state mandates.

The role requires monitoring regulatory changes and coordinating MMIS development with an emphasis on quality assurance and contract management.

Qualifications

• Knowledge of identifying, analyzing, and specifying requirements and translating them into technical requirements.
• Experience with quality assurance and configuration management of information systems.
• Understanding of Medicaid/health program administration and MMIS is a plus.

Responsibilities

• Oversee claims adjudication, pricing and payment, service authorizations, and NPI matching.
• Monitor federal and legislative mandates and regulatory changes affecting MMIS development.
• Lead and mentor team on quality assurance, contract management, and rules maintenance.

Skills

Analytical thinking

Oral communication

Written communication

Technical expertise

Job description

Job Description

Welcome to the Department of Health!

We’d be delighted to have you join our team.

This position is open to Alaskan Residents only.

Please check out the

residency definition

to determine if you qualify.

What you will be doing:

As a Medicaid Program Specialist 3 you will support the Medicaid program by providing plan administration, quality assurance, and contract management related to Medicaid claims processing and the Medicaid Management Information System. As the unit lead and subject matter expert, this position oversees claims adjudication, pricing and payment, service authorizations, NPI matching, third-party liability cost avoidance, and rules management and exception code maintenance. The position also monitors federal and legislative mandates, executive branch initiatives, and regulatory changes requiring coordinated MMIS development and implementation.

Our organization, mission, and culture:

The Health Care Services vision is to: Innovate health plans that improve the quality of health care for all Alaskans, attract excellent providers, and be known for outstanding customer service. Division of Health Care Services' core values: Through quality service, prudent use of resources, and satisfied, productive employees, we will promote good health for the people we serve via

ACCESS

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The benefits of joining our team:

We are a dynamic, innovative, and fast-paced team. All team members' input is valued, and we are always looking to provide growth and learning opportunities for our team members.

The working environment you can expect:

This position is conveniently located at 4601 Business Park Blvd, Bldg K, in midtown Anchorage, with access to restaurants, shopping, bike paths, and the nearby Cuddy Family Midtown Park. Free parking is provided. The workweek is Monday through Friday, with Monday in-office and Tuesday through Friday teleworking.

Who we are looking for:

The ideal candidate will possess some or all of the following position-specific competencies in addition to the minimum qualifications listed below:

Requirements Analysis

Knowledge of the principles and methods to identify, analyze, specify, design, and manage functional and infrastructure requirements; includes translating functional requirements into technical requirements used for logical design or presenting alternative technologies or approaches.

Configuration Management

Knowledge of the principles and methods for planning or managing the implementation, update, or integration of information systems components.

Quality Assurance

Knowledge of the principles, methods, and tools of quality assurance and quality control used to ensure a product fulfills functional requirements and standards.

To view the general description and example of duties for this job class, please go to the following link and search for

Medicaid Program Specialist 3

:

https://www.governmentjobs.com/careers/Alaska/classspecs

Minimum Qualifications

Competency-Based Minimum Qualifications Instructions

This job class uses competency-based minimum qualifications.

Please ensure your application (through work history, volunteer experience (duties summary), training, education, licenses, certifications, etc.) supports how you have gained the knowledge, skills, abilities, and behaviors (competencies) and that you possess the minimum required competencies for the job class.

Competency Description

The competency description(s) listed below have been designed to promote a common understanding of the essential elements of the job class. They highlight the more general and customary knowledge, skills, abilities (KSAs), tasks, and behaviors used to describe the competency. They typically list expectations rather than specific tasks and are to be used only as parameters and guidelines. A competency’s description is not intended to exclusively define every KSA, task, and behavior needed to successfully meet the competency, but rather to provide the manager/agency with a broad reference of options as to how an applicant can meet the job expectation.

Please ensure your application (through work history, training, education, licenses, certifications, etc.) supports/demonstrates that you possess the minimum required competencies for the job class.

Any combination of education and/or experience that provides the applicant with competencies in:

Analytical Thinking/Problem Solving

Uses a logical, systematic, and sequential approach to address problems or opportunities or manage a situation by drawing on one’s knowledge and experience base and calling on other references and resources, as necessary.

Oral Communication

Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues, and responds appropriately.

Technical Expertise

Effectively applies technical knowledge to solve a range of problems; develops technical solutions to new or highly complex problems that cannot be solved using existing methods or approaches; is sought out as an expert to provide advice or solutions in the technical area.

Written Communication

Writes in a clear, concise, organized, and convincing manner for the intended audience.

Equivalent to those typically gained by

Progressively responsible professional experience such as supporting the administration of a Medicaid or Medicare program, health insurance service, health insurance management information system, health insurance finance or accounting program, Supplemental Security Income benefits or vocational rehabilitation program; auditing or monitoring medical or public assistance programs for fraud or quality assurance; processing medical claims using medical coding and medical billing knowledge; designing, developing, testing for quality assurance, and implementing an information system and/or training or education which includes such course work as business administration, computer sciences, economics, healthcare, legal studies, medical billing or coding, public health, public assistance, psychology.

Special Note

“Competencies” means a combination of interrelated knowledge, skills, abilities, and behaviors that enable a person to act effectively in a job or situation.

“Professional experience” means work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the power or right to decide or act according to one's own judgment.

“Progressively responsible” means indicating growth and/or advancement in complexity, difficulty, or level of responsibility.

“Training” and “education” in this guidance are synonyms for the process of acquiring knowledge and skills through instruction. It includes instruction through formal and informal methods (such as classroom, on-line, self-study, and on-the-job), from accredited and unaccredited sources, and long-duration (such as a post-secondary degree) and short-duration (such as a seminar) programs.

“Typically gained by” means the prevalent, usual method of gaining the competencies expected for entry into the job.

Additional Required Information

At the time of the interview, please provide the following:

Three (3) professional references, whom we may contact by phone, are required. One (1) of these references must be your current or most recent supervisor, if not already provided in the application.

Current performance evaluation, if available.

A copy of academic transcripts (unofficial is okay; please