Medicaid Program Specialist 4 (Surveillance and Utilization Review Supervisor-PCN 064034)
State of AlaskaJob Description
- 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.This position is currently located in Anchorage. The position may be in Anchorage or Juneau, depending upon the location of the most qualified candidate.
What You Will Be Doing:
This position in the Quality Assurance section leads a team supporting Alaska’s Medicaid fraud, waste, and abuse prevention efforts. Responsibilities include overseeing provider post-payment reviews, reviewing medical records, analyzing data, recovering overpayments, and following up on tips and leads from data analysis, explanation of benefits, and the fraud and abuse hotline.The role also oversees patient-focused initiatives serving vulnerable Alaskans, including the Care Management Program and the Alaska Medicaid Coordinated Care Initiative.
Mission and Values/Culture:
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: Through quality service, prudent use of resources, and satisfied, productive employees, we will promote good health for the people we serve, via ACCESS:
- Articulate
- Competent
- Constructive
- Ethical
- Strategic
- Sincere
If you embrace these values and want to assist in HCS's mission, we encourage you to apply today.
Benefits of Joining Our Team:
The Quality Assurance team offers excellent opportunities for professional growth and career development. Team members regularly collaborate with Division leadership across the Department of Health on investigations and special projects, gaining valuable experience and visibility.
This role also works closely with federal oversight partners, providing meaningful, high-impact experience. In addition, the team supports work-life balance with a flexible hybrid schedule that includes 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. This position also features an assigned parking space for convenience.
Who We Are Looking For:- Decision Maker: Makes sound, well-informed, and objective decisions; perceives the impact and implications of decisions; commits to action, even in uncertain situations, to accomplish organizational goals; causes change.
- Managing Performance: Takes responsibility for employees’ performance by setting and communicating expectations and goals that are specific and measurable, tracking progress against the goals, supporting employees’ efforts to achieve job goals (by providing resources, removing obstacles, acting as a buffer, etc.), ensuring feedback, and addressing performance problems and issues promptly.
- 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.
To view the general description and example of duties for this job class, please go to the following link and search for [Job Class Title]: https://www.governmentjobs.com/careers/Alaska/classspecs Minimum Qualifications
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.
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 instead of 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 meet the competency successfully but rather to provide the manager/agency with a broad reference of options as to how an applicant can meet the job expectation.
Please ensure your application (through work history, training, education, licenses, certifications, etc.) supports/demonstrates you possess the minimum required competencies for the job class.
Minimum Qualifications:
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.
- Organizational Awareness: Knows the organization's mission and functions, and how its social, political, and technological systems work and operates effectively within them; this includes the programs, policies, procedures, rules, and regulations of the organization.
- 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; 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.
Additional Required Information
At the time of the interview, please provide the following:
- Three (3) professional references whom we may contact by phone, one (1) of whom must be your current or most recent supervisor, if not already provided in the application.
- A copy of academic transcripts (unofficial are okay; please ensure that the institution name/URL is listed on the transcripts) is used to support that you meet the minimum qualification competencies.
- A Technical writing sample.
SUPPLEMENTAL QUESTIONS
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 level of competence in applying certain 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.
EDUCATION
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 application does not support minimum qualifications, the applicant may not advance to the interview and selection phase of the recruitment A resume will not be used to determine that minimum qualifications have been met for the position you are applying for.
If you have currently or previously been appointed to a flexibly staffed position, please ensure your work experience within a flexibly staffed position indicates the actual dates employed at each level Ensure your time and any subsequent flex promotion(s) are documented as a separate position This is required as minimum qualifications require experience at a particular level in which the lower level may not be considered If this information is not accurately reflected in your application, this may cause the processing of your application for consideration to be delayed.
NOTE: Attaching a resume or curriculum vitae is not an alternative to filling out the application. Noting "see resume or CV" or any similar response on any portion of your application may lead to a determination that your application is incomplete and removal from consideration for this job posting.
The State of Alaska does not provide VISA Employer sponsorships.MULTIPLE LOCATIONS:The location of this position is currently in Anchorage. The position may be located in Anchorage and Juneau, depending upon the location of the most qualified candidate. Please select the location(s) you are willing to be considered for. There is one position to be filled.
MULTIPLE VACANCIES
This recruitment may be used for more than one (1) vacancy. The applicant pool acquired during this recruitment may be used for future vacancies for up to ninety (90) days after this recruitment closes. Interested applicants are encouraged to apply to each recruitment notice to ensure consideration for all vacancies.
APPLICATION NOTICE
You can ONLY apply for this position through the Workplace Alaska website or via a hard copy application. If you accessed this recruitment bulletin through a job search portal such as Alaska Jobs or another database, you MUST use a Workplace Alaska online or hard-copy application to apply successfully. Instructions on how to apply with Workplace Alaska may be found on the Workplace Alaska "How to Apply" webpage, found here: http://doa.alaska.gov/dop/workplace/help/
NOTICE
Questions regarding the application process can be directed to the Workplace Alaska hotline at 800-587-0430 (toll-free) or (907) 465- 4095. If you choose to be contacted by email, please ensure that your email address is correct on your application and that your spam filter will permit emails from the 'governmentjobs.com' domain. For information on allowing emails from the 'governmentjobs.com' domains, visit the Lost Password Help page at https://www.governmentjobs.com/OnlineApplication/User/ResetPassword.
EEO STATEMENT
The State of Alaska complies with Title I of the Americans with Disabilities Act (ADA). Individuals with disabilities who require accommodations, auxiliary aids, or services, or alternative communication formats, please call 1-800-587-4095 in Juneau, or TTY: Alaska Relay at 711 or 1-800-770-8973, or correspond with the Division of Personnel & Labor Relations at P.O. Box 110201, Juneau, AK 99811-0201. The State of Alaska is an equal-opportunity employer.
WORKPLACE ALASKA APPLICATION QUESTIONS & ASSISTANCE
Questions regarding application submission or system operation errors should be directed to the Workplace Alaska hotline at 1-800-587-0430 (toll-free) or (907) 465-4095 if you are in the Juneau area. Requests for information may also be emailed torecruitment.services@alaska.gov.
For assistance with applying for a password, please visithttps://www.governmentjobs.com/OnlineApplication/User/ResetPassword.Contact Information
- Name/Title: Tracey Marshall - Quality Assurance ManagerPhone: 907-310-5090Email: Tracey.Marshall@alaska.gov