Medicaid Program Specialist 2 (PCN 064099)

State of Alaska • Anchorage, AK

13h • Hybrid

About The Position

This Individual Position is Exempt from the Hiring Freeze. Qualified Applicants are Encouraged To Apply. 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, apply today! This position is open to Alaskan Residents only. Please check out the residency definition to determine if you qualify. As the Medicaid Program Specialist 2, you will conduct Medicaid provider-focused reviews to ensure compliance with applicable state and federal requirements and assess overutilization and/or potential fraud, waste, and abuse. Your responsibilities will include reviewing and processing submitted Medicaid provider self-audits for compliance with AS 47.05.235 and 7 AAC 160.115. You will collaborate with staff from DOH partner agencies, the Medicaid Fraud Control Unit, and federal oversight agencies to enhance program integrity.

Requirements

• Attention to Detail: Is thorough when performing work and conscientious about attending to detail.
• Investigation: Knowledge of the guidelines, regulations, and procedures associated 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.
• 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.
• Written Communication: Writes in a clear, concise, organized, and convincing manner for the intended audience.
• Progressively responsible 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.

Responsibilities

• Conduct Medicaid provider-focused reviews to ensure compliance with applicable state and federal requirements.
• Assess overutilization and/or potential fraud, waste, and abuse.
• Review and process submitted Medicaid provider self-audits for compliance with AS 47.05.235 and 7 AAC 160.115.
• Collaborate with staff from DOH partner agencies, the Medicaid Fraud Control Unit, and federal oversight agencies to enhance program integrity.

Benefits

• 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).
• Hybrid work schedule which includes time in the office and time teleworking.
• Collaborative and supportive work environment.
• Professional office environment with daily collaboration among dedicated colleagues.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed