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Role Description

This position serves as the specialist in the Managed Care System Operations section. With assistance from a Departmental Analyst, directs functions related to the processing of managed care encounters. These encounters are used to monitor the quality of care by the health plans and provide data for managed care rate setting, research projects, case management studies, and other requested data extracts; they support the Department in assessing the effectiveness of Medicaid managed care programs.

• Monitors the submission of data from many different types of managed care health plans on a statewide basis.
• Communicates encounter requirements to both internal and external stakeholders.
• Analyzes test data from the managed care entities and grants approval for submission of production encounter data.
• Plans and oversees changes in data submission due to program additions or modifications, new HIPAA or ACA regulations, and/or department initiatives.
• Develops and executes user testing scenarios related to encounters in CHAMPS as defects are fixed and enhancements are instituted.
• Creates ad-hoc queries using Bi-Query software in the Data Warehouse to analyze and monitor large sets of encounter data for compliance and accuracy.

Qualifications

• Possession of a bachelor’s degree in any major.
• Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level.

Requirements

• Apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
• Relevant experience and/or education referred to in supplemental questions must be documented in resume, transcript and/or application to allow for accurate screening.
• Attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
• Attach a cover letter.
• If applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts.
• Failure to complete any of the above items may result in your application not being considered.

Benefits

• The physical location of this position is 400 S. Pine Street, with remote options available.
• Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered.
• Employees will be provided computers to perform state work. Phones may also be provided for necessary communications.
• If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:
  • A secure work location that allows privacy and prevents distractions.
  • A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
  • Suitable lighting, furniture, and utilities.