Medicaid Program Specialist 3 (PCN 067010)

State of Alaska; Anchorage (AK); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

State of Alaska is seeking a Medicaid Program Specialist 3 in Anchorage. You will support CMS PERM processes, respond to errors, and engage with Medicaid providers to gather documentation.

This role emphasizes policy applications, detailed investigations, and ensuring program integrity. The position requires analyzing complex provider issues, using MMIS, Cognos, and data warehouses to identify billing and compliance concerns, and recommending corrective actions.

Qualifications

• Requires thorough attention to detail and ability to identify factual inferences.
• Experience in applying regulatory guidelines to audits and reviews.
• Ability to document findings clearly in oral and written form.

Responsibilities

• Research CMS PERM-related errors and request information from Medicaid providers as needed.
• Investigate provider compliance issues and analyze claims using MMIS and Cognos tools.
• Perform focused provider reviews and develop corrective actions to improve performance.

Skills

Attention to Detail

Investigation

Compliance

Analytical Thinking

Oral Communication

Written Communication

Technical Expertise

Tools

MMIS

Cognos

Data warehouse

Claims retrieval tools

Job description

Medicaid Program Specialist 3 (PCN 067010) in Anchorage, AK

Welcome to the Department of Health!

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

If you envision yourself in this role and are ready to start an exciting career with us,

This position is open to Alaskan Residents only. Please check out the residency definition to determine if you qualify.

What you will be doing:

• 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-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.

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 experiences 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, online, 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.

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.

The State of Alaska does