Medicaid Program Specialist 3 (PCN 067029)

State of Alaska • Anchorage, AK

2d • Hybrid

About The Position

The Medicaid Program Specialist 3 supports Alaska’s Medicaid program through plan administration, quality assurance, and contract management related to Medicaid claims processing and the Medicaid Management Information System (MMIS). Serving as a unit lead and subject matter expert, the position oversees claims adjudication, pricing and payment, service authorizations, NPI matching, third-party liability cost avoidance, rules management, and exception code maintenance. The specialist also monitors federal and legislative mandates, executive branch initiatives, and regulatory changes that require coordinated MMIS development and implementation.

The position is based at 4601 Business Park Blvd, Building K, in midtown Anchorage. The workweek is Monday through Friday, with Monday in the office and Tuesday through Friday teleworking. The position is open to Alaska residents only.

Requirements

• Possess competencies in analytical thinking/problem solving, oral communication, technical expertise, and written communication, gained through an applicable combination of education and/or experience.
• Equivalent qualifications may include progressively responsible professional experience supporting Medicaid or Medicare administration, health insurance services or management information systems, health insurance finance or accounting, Supplemental Security Income benefits, vocational rehabilitation, auditing or monitoring medical or public assistance programs, medical claims processing using medical coding and billing knowledge, or information-system design, development, quality testing, implementation, or related training and education.
• Applicants must be Alaska residents.
• Provide three professional references at the interview, including the current or most recent supervisor if not already provided, and a current performance evaluation if available.
• Provide transcripts to verify education used to meet or support minimum qualifications; foreign education used for qualification must have the required equivalency evidence.
• Document qualifying work experience in the application, including employer, job title, dates, and full-time or part-time status where applicable.

Nice To Haves

• Knowledge of requirements analysis, including identifying, analyzing, specifying, designing, and managing functional and infrastructure requirements and translating functional requirements into technical requirements.
• Knowledge of configuration management methods for planning or managing implementation, updates, or integration of information-system components.
• Knowledge of quality assurance and quality control principles, methods, and tools.

Responsibilities

• Provide plan administration, quality assurance, and contract management related to Medicaid claims processing and the Medicaid Management Information System.
• Serve as a unit lead and subject matter expert.
• Oversee claims adjudication, pricing and payment, service authorizations, NPI matching, third-party liability cost avoidance, rules management, and exception code maintenance.
• Monitor federal and legislative mandates, executive branch initiatives, and regulatory changes requiring coordinated MMIS development and implementation.

Benefits

• The department describes the team as dynamic, innovative, and fast-paced; team members’ input is valued, with growth and learning opportunities available.
• Free parking is provided.

What This Job Offers

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