Medicaid Program Specialist 4 (065107)

State of Alaska•Anchorage, AK

4d•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. This position is currently located in Anchorage. In this supervisory position, you and your team ensure behavioral health claims and reimbursement align with program expectations and support high-quality care. Through billing and program guidance, claim analysis, provider reviews, and other quality assurance activities, you will help develop, implement, and administer Alaska Medicaid's behavioral health programs. You will also oversee Fiscal Agent activity, analyze federal and state regulations, apply national coding standards, and stay aware of clinical recommendations. Your knowledge of the behavioral health system, medical claims, and Medicaid policies informs how you apply your problem-solving, organization, and program skills. This is an opportunity to directly influence the alignment of behavioral health services with state and federal regulations, while driving continuous improvement in provider performance. If you're passionate about making a meaningful impact on Alaska's healthcare future, we would like to hear from you. The mission of the Division of Behavioral Health is to promote an integrated and comprehensive behavioral health system based on sound policy, effective practices, and partnerships. Our Division Values: Connection, Collaboration, and Community. We are a small, dynamic team with opportunities to pursue your areas of interest and training to grow your skill set. We value employees with compassion, diversity, and integrity. This position is being recruited for in Anchorage and offers a hybrid telework environment.

Requirements

Progressively responsible professional 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.
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.
Knowledge of the principles and practices for monitoring, evaluating, and ensuring accountability for program performance and outcomes (Program Oversight).
Formulates objectives and priorities and implements plans consistent with the long-term interests of the organization in a global environment. Capitalizes on opportunities and manages risks (Strategic Thinking).
Is open to change and new information; adapts behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with ambiguity and uncertainty (Flexibility).
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 (Analytical Thinking/Problem Solving).
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 (Oral Communication).
Knows the organization's mission and functions, and how its social, political, and technological systems operate effectively within them; this includes the organization's programs, policies, procedures, rules, and regulations (Organizational Awareness).
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 (Technical Expertise).
Writes in a clear, concise, organized, and convincing manner for the intended audience (Written Communication).

Nice To Haves

Knowledge of the behavioral health system, medical claims, and Medicaid policies.

Responsibilities

Ensure behavioral health claims and reimbursement align with program expectations and support high-quality care.
Develop, implement, and administer Alaska Medicaid's behavioral health programs through billing and program guidance, claim analysis, provider reviews, and other quality assurance activities.
Oversee Fiscal Agent activity.
Analyze federal and state regulations.
Apply national coding standards.
Stay aware of clinical recommendations.
Apply problem-solving, organization, and program skills informed by knowledge of the behavioral health system, medical claims, and Medicaid policies.
Influence the alignment of behavioral health services with state and federal regulations.
Drive continuous improvement in provider performance.