Featured Job: Medicaid Health Systems Specialist

Job Duties

Under general direction, monitors & evaluates providers, projects, program (e.g., may include components) or service delivery by participation on or leads a team to &/or works independently to: Conduct complex analysis (e.g., researches & analyses policy, techniques & procedures for Just Cause & Waiver Disenrollment, Inpatient & Continuity of Care Deferments including reconciliation & reimbursement strategies for Medicaid-contracting Managed Care Plans [MCPs] & eligible consumers) determines & implements necessary Client Registry Information System – Enhanced (CRIS-E)/Medicaid Management Information System (MMIS) & other programmatical changes & discrepancies; monitors & evaluates program policies & procedures to assure compliance with federal & state regulations; summarizes findings & recommendations for change on health care related issues using complex computer systems [e.g., MMIS, CRIS-E, Decision Support System (DSS) databases] & initiates & completes complex, technical reports related to these issues; interacts directly with consumers, MCPs, providers & other interested parties in the compilation of data to determine appropriate MCP enrollment eligibility actions; notifies affected parties of actions (e.g., approval/denial of enrollment); verifies with consumers & providers that MCP follow-up action is completed by tracking concerns & resolutions; responds to inquiries by consumers, providers, county agencies, MCP & government officials by telephone, correspondence &/or in person.

Provides consultive expertise & training & acts as liaison to both intra-agency & inter-agency providers (e.g., Medicaid-contracting MCPs, Bureau of Community Services Policy); acts as team leader to gather & analyze data & in the design of required forms; consults with MCP officials, county agencies & other entities regarding current & forthcoming program changes; coordinates activities performed by other entities which are directly associated with the administration &/or implementation of policies pertaining to Medicaid-contracting MCPs; verifies reimbursements request & claims adjustments resulting from eligibility actions; represents agency at hearings, conferences, meetings & workshops; serves on committees & taskforces; prepares complex, technical reports, correspondences & memorandums.


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