Medicaid Program Specialist 3 (PCN 067029)

State of Alaska; Anchorage (AK); On-site; USD 90,000 - 125,000; Full time

Job summary

State of Alaska is seeking a Medicaid Program Specialist 3 in Anchorage to lead Medicaid claims processing, MMIS system management, and contract administration. You will supervise adjudication, pricing, service authorizations, and cost avoidance while tracking federal mandates and regulatory changes.

The role requires strong analytical thinking, quality assurance, and communication skills to coordinate with multiple stakeholders in a dynamic government environment.

Qualifications

• Analytical thinking and problem solving are required to identify and address complex issues.
• Clear oral and written communication for diverse audiences is essential.
• Knowledge of quality assurance concepts and methods is expected.

Responsibilities

• Support the Medicaid program by managing plan administration, QA, and contract oversight for claims processing and MMIS.
• Lead unit operations including claims adjudication, pricing, service authorizations, and regulatory tracking.

Skills

Analytical Thinking

Oral Communication

Written Communication

Problem Solving

Configuration Management

Quality Assurance

Job description

Medicaid Program Specialist 3 (PCN 067029) in Anchorage, AK | GovernmentJobs.com page has loaded.

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, apply today!

This position is open to Alaskan Residents only.

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:

• Articulate
• Competent
• Constructive
• Ethical
• Strategic
• Sincere

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 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.

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.

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: ...

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 ensure that the institution name/URL is listed on the transcripts) is used to support that you meet the minimum qualifications competencies.

To verify education is being used to meet and/or support the required minimum qualifications/competencies, you must fill in the Education section of the application If you have not obtained a degree, please indicate the number of units completed Copies of transcripts are required to verify educational credentials used to meet or support the minimum qualifications/competencies for a position and are required with each application (Unofficial is okay; please ensure the institution/URL name is listed on the transcripts) Transcripts can be attached at the time of application or provided at the time of interview; if not, transcripts will be required before employment.

If education is completed in a foreign college or university, it may be used to meet the above requirements, if applicable. If utilizing this education, you must show that the education credentials have been submitted to a private organization that specializes in the interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university. It is your responsibility to provide such evidence when applying.

When using work experience not documented in your application, please provide the employer's name, job title, employment dates, and whether you worked full-time or part-time. Applications will be reviewed to determine if the responses are supported and if minimum qualifications are met. Work experience needed to meet the minimum qualifications must be documented in the application. If the application does not support minimum qualifications, the applicant may not advance to the interview and selection phase of the recruitment. A resume will not be used to determine that minimum qualifications have been met for the position you are applying for.

If you have currently or previously been appointed to a flexibly staffed position, please ensure your work experience within a flexibly staffed position indicates the actual dates employed at each level. Ensure your time and any subsequent flex promotion(s) are documented as a separate position. This is required as minimum qualifications require experience at a particular level in which the lower level may not be considered. If this information is not accurately reflected in your application, this may cause the processing of your application for consideration to be delayed.

NOTE: Attaching a resume or curriculum vitae is not an alternative to filling out the application.

THE STATE OF ALASKA DOES NOT PROVIDE VISA EMPLOYER SPONSORSHIPS.

EEO Statement

The State of Alaska complies with Title I of the Americans with Disabilities Act (ADA). Individuals with disabilities who require accommodations, auxiliary aids, or services, or alternative communication formats, please call 1-800-587-4095 in Juneau or TTY: Alaska Relay 711 or 1-800-770-8973 or correspond with the Division of Personnel & Labor Relations at P.O. Box 110201, Juneau, AK 99811-0201. The State of Alaska is an equal-opportunity employer.

Contact Information

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

Name/Title: Revathy Smith / Medicaid Program Specialist 4

Phone: [phone]

Email: [e-mail]

Phone [phone] (Statewide toll-free number)

[phone] (Juneau and out-of-state callers)