Medicaid Program Specialist 3

State of Alaska; Anchorage (AK); Ibrido; USD 75.000 - 105.000; Tempo pieno

Vantaggi offerti da questo lavoro

Hybrid work schedule

Free parking

Professional development opportunities

Descrizione del lavoro

State of Alaska seeks a Medicaid Program Specialist 3 to support Medicaid program oversight by reviewing provider compliance, claims, and utilization. The role is located in Anchorage within the Quality Assurance Section and emphasizes data analysis and actionable recommendations.

The position offers a hybrid work schedule, professional development opportunities through CMS/NAMPI/NHCAA, and a collaborative, security-conscious team environment.

Competenze

• Attention to detail in evaluating provider data and documentation.
• Investigation knowledge: guidelines, regulations, and procedures.
• Compliance: assess, evaluate, and monitor programs for compliance with laws and guidance.

Mansioni

• Support CMS PERM process by researching errors and contacting Medicaid providers to obtain information.
• Research moderate to complex provider compliance issues and claims per Medicaid policy.
• Conduct focused provider reviews using MMIS, Cognos, the MMIS data warehouse, and claims tools; analyze data and develop corrective action recommendations.

Conoscenze

Attention to Detail

Investigation

Compliance

Analytical Thinking

Oral Communication

Technical Expertise

Written Communication

Strumenti

MMIS

Cognos

Data Warehouse

Claims Retrieval Tools

Descrizione del lavoro

Medicaid Program Specialist 3 (PCN 067010) | Workplace Alaska page has loaded.

What you will be doing:
Within the Quality Assurance Section, this role supports Medicaid program oversight by conducting comprehensive reviews of provider compliance, claims, and utilization. Responsibilities include

• Supporting the Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) process by researching and responding to errors identified by CMS contractors and contacting Medicaid providers, when necessary, to obtain requested information and documentation.
• Researching moderate to complex provider compliance issues and claims, applying Medicaid policy and provider requirements.
• Conducting focused provider reviews using the Medicaid Management Information System (MMIS), Cognos queries, the MMIS data warehouse, and claims retrieval tools. Data and findings are analyzed to identify billing, compliance, utilization, and program integrity concerns and to develop recommendations for corrective action and improved provider performance.

These activities strengthen Medicaid program oversight, promote provider compliance, and help identify and reduce fraud, waste, abuse, and inappropriate expenditures of Medicaid funds.
Our organization, mission, and culture:
The Department of Health, Medicaid Program Integrity is a small team whose mission is to preserve and protect the integrity of the Medicaid program by proactively developing strategies to identify, deter, and prevent fraud, waste, and abuse.

The benefits of joining our team:
This position provides you with an opportunity to work with a team of professionals dedicated to safeguarding the integrity of the Medicaid program by proactively developing strategies to prevent fraud, waste, and abuse. Our team encourages continual learning, including training opportunities through the Medicaid Integrity Institute (MII) hosted by Centers for Medicare and Medicaid Services (CMS), the National Association for Medicaid Program Integrity (NAMPI), and the National Health Care Anti-Fraud Association (NHCAA). Team members currently enjoy a hybrid work schedule that includes time in the office and time teleworking and encourages a collaborative and supportive work environment.

The working environment you can expect:
This position is in the Frontier Building in midtown Anchorage, a secure office space with free parking. We offer a professional office environment with daily collaboration among dedicated colleagues and offer a hybrid work schedule.

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:

• Attention to Detail: Is thorough when performing work and conscientious about attending to detail.
• Investigation: Knowledge of the guidelines, regulations, and procedures associate with investigation, including interviewing, evidence detection, locating, gathering and handling, and drawing appropriate factual inferences and conclusions. Provide oral or written reports of findings. Presenting evidence and providing testimony.
• Compliance: Knowledge of procedures for assessing, evaluating, and monitoring programs or projects for compliance with federal laws, regulations, and guidance.

Competency Description

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 experiencesuch 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.

For specific information in reference to the position, feel free to contact the hiring manager at:

Phone [phone] (Statewide toll-free number)
[phone] (Juneau and out-of-state callers)