Medicaid Program Specialist ; PCN

Medicaid Program Specialist 2

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 2, you will conduct Medicaid provider-focused reviews to ensure compliance with applicable state and federal requirements and assess over utilization and/or potential fraud, waste, and abuse. Your responsibilities will include reviewing and processing submitted Medicaid provider self-audits for compliance with AS 47.05.235 and 7 AAC 160.115. You will collaborate with staff from DOH partner agencies, the Medicaid Fraud Control Unit, and federal oversight agencies to enhance program integrity.

Our organization, mission, and culture:
The Department of Health, Medicaid Program Integrity is a small team whose mission is to preserve and protect the integrity of the Medicaid program by proactively developing strategies to identify, deter, and prevent fraud, waste, and abuse. The benefits of joining our team:
This position will provide you with an opportunity to work with a team of professionals dedicated to safeguarding the integrity of the Medicaid program by proactively developing strategies to prevent fraud, waste, and abuse. Our team encourages continual learning, including training opportunities through the Medicaid Integrity Institute (MII) hosted by Centers for Medicare and Medicaid Services (CMS), the National Association for Medicaid Program Integrity (NAMPI), and the National Health Care Anti-Fraud Association (NHCAA).

Team members currently enjoy a hybrid work schedule which includes time in the office and time teleworking and encourages a collaborative and supportive work environment. The working environment you can expect:
This position is in the Frontier Building in midtown Anchorage, a secured office space with free parking. We offer a professional office environment with daily collaboration among dedicated colleagues and a hybrid work schedule.

Who we are looking for:

• Attention to Detail:
  Is thorough when performing work and conscientious about attending to detail.
• Investigation:
  Knowledge of the guidelines, regulations, and procedures associated with investigation, including interviewing, evidence detection, locating, gathering and handling, and drawing appropriate factual inferences and conclusions. Provide oral or written reports of findings. Presenting evidence and providing testimony.
• Compliance:
  Knowledge of procedures for assessing, evaluating, and monitoring programs or projects for compliance with federal laws, regulations, and guidance.

To view the general description and example of duties for this job class, please go to the following link and search for [Medicaid Program Specialist 2]:

Minimum qualifications:

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. Competency Description The competency description(s) listed below have been designed to promote a common understanding of the essential elements of the job class.

They highlight the more general and customary knowledge, skills, abilities (KSAs), tasks, and behaviors used to describe the competency. They typically list expectations rather than specific tasks and are to be used only as parameters and guidelines. A competency's description is not intended to exclusively define every KSA, task, and behavior needed to successfully meet the competency, but rather to provide the manager/agency with a broad reference of options as to how an applicant can meet the job expectation.

Any combination of education and/or experience that provides the applicant with competencies in

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.

Equivalent to those typically gained by:

Progressively responsible…