Medicaid Program Specialist 3

Job Posting

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 3, within the Division of Health Care Services, Quality Assurance Unit, you will manage the Care Management Program (CMP) and Alaska Medicaid Coordinated Care Initiative (AMCCI). You will focus on reducing Medicaid misuse, improving care coordination, and promoting communication among providers, pharmacies, and members. Your responsibilities include developing program metrics, monitoring claims and care patterns, collaborating with healthcare professionals and contractors, overseeing member enrollment and discharge activities, serving as a subject matter expert, and ensuring vendor contract compliance.

Our ideal applicant will demonstrate initiative, strong interpersonal skills, and the ability to adapt in a dynamic healthcare environment.

The Health Care Services mission is to: Provide all eligible Alaskans with access to and oversight of the full range of appropriate Medicaid services. We also protect Alaska's most vulnerable populations through our certification and licensing programs.

The Health Care Services vision is to: Innovate health plans that improve quality of health care for all Alaskans, attract excellent providers, and deliver outstanding customer service.

Division of Health Care Services' core values:

• Articulate
• Competent
• Constructive
• Ethical
• Strategic
• Sincere

If you are someone who embraces these values and wants to assist in the mission of HCS, we encourage you to apply today.

The benefits of joining our team:

We are a dynamic, diverse, high-performing team that focuses on excellent customer service and accuracy. The incumbent will work with a team of highly dedicated, hardworking individuals committed to ensuring the health, well-being, and safety of our vulnerable population. The work environment is positive, professional, constructive, and detail-oriented. This role also works closely with federal oversight partners, providing meaningful, high-impact experience. In addition, the team supports work-life balance through a flexible hybrid schedule with a mix of in-office and remote workdays.

The working environment you can expect:

Our office space is in the heart of Anchorage, close to many amenities, such as shopping, parks, and dining. The workspace is clean, bright, and features mountain views from the office suite. Employees are on a telework rotation and receive an assigned parking space for convenience.

Who we are looking for:

• 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.
• Self-Management: Sets well-defined and realistic personal goals; displays a high level of initiative, effort, and commitment towards completing assignments in a timely manner; works with minimal supervision; is motivated to achieve; demonstrates responsible behavior.
• Program Oversight: Plans, coordinates, and monitors programs to ensure that federal, state, and/or local government program requirements and plans are met, providing professional consultation on the specialized services of the program or associated project(s).

Competency-Based Minimum Qualifications Instructions This job class uses competency-based minimum qualifications. Please ensure your application (through work history, volunteer experience (duties summary), training, education, licenses, certifications, etc.) supports how you have gained the knowledge, skills, abilities, and behaviors (competencies) and that you possess the minimum required competencies for the job class.

Competencies include:

• 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.
• Technical Expertise: 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.
• Written Communication: Writes in a clear, concise, organized, and convincing manner for the intended audience.

Equivalent to those typically gained by:

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; 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.

Special Note:

"Competencies" means a combination of interrelated knowledge, skills, abilities, and behaviors that enable a person to act effectively in a job or situation.

"Professional experience" means work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the power or right to decide or act according to one's own judgment.

"Progressively responsible" means indicating growth and/or advancement in complexity, difficulty, or level of responsibility.

"Training" and "education" in this guidance are synonyms for the process of acquiring knowledge and skills through instruction. It includes instruction through formal and informal methods (such as classroom, on-line, self-study, and on-the-job), from accredited and unaccredited sources, and long-duration (such as a post-secondary degree) and short-duration (such as a seminar) programs.

"Typically gained by" means the prevalent, usual method of gaining the competencies expected for entry into the job.

At the time of the interview, please provide the following:

1. Three (3) professional references, whom we may contact by phone, are required. One (1) of these references must be your current or most recent supervisor, if not already provided in the application.
2. Copies of your 3 most current performance evaluations, if available.
3. A copy of academic transcripts (unofficial is okay; please ensure that the institution name/URL is listed on the transcripts) is used to support that you meet the minimum qualifications competencies.

For your application to be evaluated, you must answer the Supplemental Questions. The State of Alaska uses four proficiency levels to measure and describe an applicant's competence in applying specific behaviors, knowledge, skills, and abilities to accomplish a specific task. The four proficiency levels are Mastery, Fluency, Literacy, and Discovery. You must rate your proficiency level for each competency listed in the supplemental questions.

To verify education is being used to meet and/or support the required minimum qualifications/competencies, you must fill in the Education section of the application If you have not obtained a degree, please indicate the number of units completed. Copies of transcripts are required to verify educational credentials used to meet or support the minimum qualifications/competencies for a position and are required with each application (Unofficial is okay; please ensure the institution/URL name is listed on the transcripts) Transcripts can be attached at the time of application or provided at the time of interview; if not, transcripts will be required before employment.

Special Instructions for Foreign Education If education is completed in a foreign college or university, it may be used to meet the above requirements, if applicable. If utilizing this education, you must show that the education credentials have been submitted to a private organization that specializes in the interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university. It is your responsibility to provide such evidence when applying. The omission of the required documentation listed will result in an incomplete application, and you will not receive further consideration.

Work Experience When using work experience not documented in your application, please provide the employer's name, job title, employment dates, and whether you worked full-time or part-time. Applications will be reviewed to determine if the responses are supported and if minimum qualifications are met. Work experience needed to meet the minimum qualifications must be documented in the application. If the