Medicaid Program Specialist 3 (PCN 067010)

State of Alaska•Anchorage, AK

1d•Hybrid

About The Position

Within the Department of Health’s Quality Assurance Section, the Medicaid Program Specialist 3 supports oversight of the Medicaid program by conducting comprehensive reviews of provider compliance, claims, and utilization. The position supports the Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) process by researching and responding to errors identified by CMS contractors and, when necessary, contacting Medicaid providers to obtain requested information and documentation. The role researches moderate to complex provider compliance issues and claims, applying Medicaid policy and provider requirements. It conducts focused provider reviews using the Medicaid Management Information System (MMIS), Cognos queries, the MMIS data warehouse, and claims retrieval tools. The specialist analyzes data and findings to identify billing, compliance, utilization, and program integrity concerns, and develops recommendations for corrective action and improved provider performance. These activities help strengthen Medicaid oversight, promote provider compliance, and identify and reduce fraud, waste, abuse, and inappropriate expenditures of Medicaid funds. The position is part of the Department of Health’s small Medicaid Program Integrity team, whose mission is to preserve and protect Medicaid program integrity by proactively developing strategies to identify, deter, and prevent fraud, waste, and abuse. The role is based in a secure office in the Frontier Building in midtown Anchorage. The team currently has a hybrid schedule with time in the office and teleworking.

Requirements

Demonstrate the competencies of analytical thinking/problem solving, oral communication, technical expertise, and written communication through an appropriate combination of education and/or experience.
Possess experience or training equivalent to progressively responsible professional experience in areas such as administering Medicaid or Medicare programs, health insurance services or systems, health insurance finance or accounting, Supplemental Security Income benefits, vocational rehabilitation, auditing or monitoring medical or public assistance programs, medical claims processing using coding and billing knowledge, or information systems quality assurance and implementation.
The ideal candidate demonstrates attention to detail, investigation skills, and knowledge of compliance procedures for assessing, evaluating, and monitoring programs against federal laws, regulations, and guidance.
Applicants must be Alaska residents.
At interview, provide three professional references available by phone; one must be the current or most recent supervisor if not already included in the application.
Provide a current performance evaluation if available.
Provide transcripts to support education used to meet or support minimum qualifications; unofficial transcripts are acceptable if the institution name or URL is shown.

Nice To Haves

Training opportunities through the Medicaid Integrity Institute (MII), the National Association for Medicaid Program Integrity (NAMPI), and the National Health Care Anti-Fraud Association (NHCAA) are available to team members.

Responsibilities

Support the CMS Payment Error Rate Measurement (PERM) process by researching and responding to errors identified by CMS contractors.
Contact Medicaid providers when necessary to obtain requested information and documentation.
Research moderate to complex provider compliance issues and claims, applying Medicaid policy and provider requirements.
Conduct focused provider reviews using the MMIS, Cognos queries, the MMIS data warehouse, and claims retrieval tools.
Analyze data and findings to identify billing, compliance, utilization, and program integrity concerns.
Develop recommendations for corrective action and improved provider performance.
Contribute to identifying and reducing fraud, waste, abuse, and inappropriate expenditures of Medicaid funds.