Medicaid Program Specialist I (Certification Reviewer, PCN 062351)

State of Alaska • Anchorage, AK

9d • 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. What you will be doing: As the Medicaid Program Specialist I, Certification Reviewer, you will play a key role in the certification process for current and prospective Medicaid Home and Community-Based Services (HCBS) providers. As a member of the Provider Certification and Compliance Unit, you will be primarily responsible for reviewing and evaluating applications in accordance with applicable standards for HCBS providers (waiver and personal care services) who apply to obtain or maintain certification to participate in Medicaid. You will review and analyze provider documentation and issue determinations on certification applications, track and trend issues with providers, and make recommendations for quality improvement activities. In addition, you will serve in a vital technical assistance role for providers as well as process changes in provider statuses during certification periods. Collaboration with appropriate partner agencies and referrals for inappropriate service provisions and/or non-compliance are also included in the duties of this position. Some Travel may be required in this postion.

Requirements

• Reading Comprehension: Understands and interprets written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations.
• Writing: Recognizes or uses correct English grammar, punctuation, and spelling; communicates information (for example, facts, ideas, or messages) in a succinct and organized manner; produces written information, which may include technical material, that is appropriate for the intended audience.
• Interpersonal Skills: Shows understanding, friendliness, courtesy, tact, empathy, concern, and politeness to others; develops and maintains effective relationships with others; may include effectively dealing with individuals who are possibly difficult, hostile, or distressed; relates well to people from varied backgrounds and different situations; is sensitive to cultural diversity, race, gender, disabilities, and other individual differences.
• 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.
• Experience 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.
• Experience auditing or monitoring medical or public assistance programs for fraud or quality assurance.
• Experience processing medical claims using medical coding and medical billing knowledge.
• 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

• Reviewing and evaluating applications in accordance with applicable standards for HCBS providers (waiver and personal care services) who apply to obtain or maintain certification to participate in Medicaid.
• Review and analyze provider documentation and issue determinations on certification applications.
• Track and trend issues with providers.
• Make recommendations for quality improvement activities.
• Serve in a vital technical assistance role for providers.
• Process changes in provider statuses during certification periods.
• Collaboration with appropriate partner agencies.
• Referrals for inappropriate service provisions and/or non-compliance.

What This Job Offers

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