Medicaid Program Specialist IV

Workplace Alaska - Juneau, AK

Full-time | Part-time | Contract
This position is open to Alaska Residents only.
Please check our residency definition to determine if you qualify.

Under the general direction of the Health Care Services Director, this position serves as the Children's Health Insurance Program (CHIP) Administrator for the state of Alaska. The incumbent will have statewide responsibility for the development, implantation, evaluation and administration/management of the children's Medicaid program.

The position is responsible for ensuring the program's compliance with state and federal policies, regulations and statutory requirements under the early periodic screening diagnosis and treatment (EPSDT) children's Medicaid service provision. The incumbent is also tasked with children's program integrity; quality improvement, performance and access; budget development; program financing; outreach, enrollment and training across the Department and to external and internal stakeholder groups statewide.

The incumbent administers and manages the Tribal Medicaid Administrative Claiming Project (TMAC) for the Tribal Health Organizations in Alaska. Position manages Tribal contracts, and coordinates with the Department Medicaid Tribal Liaison, DHCS administrative staff and Office of Rate Review, DHSS fiscal units, and statewide Tribal stakeholder groups to administer this project.

The incumbent serves on national committees and work groups and is the Department of Health and Social Services representative/liaison for children's Medicaid/CHIP with the Centers of Medicare and Medicaid Services (CMS) and the National Academy of State Health Policy (NASHP) CHIP Directors' organization. The wiliness and ability to travel multiple times a year is a desired quality.

Key Responsibilities include, but are not limited to:
Responsible for formulating and implementing Medicaid/CHIP policy, regulations and statutes at the state level;
Monitors and ensures compliance with federal policy, regulations and statutes; evaluates new federal requirements and writes and makes recommendations for amendments for inclusion in both the state's Medicaid and CHIP State Plans for CMS approval;
Writes grant/contract project proposals and makes recommendations to the Division Director for leadership approval; writes and certifies the CMS children's annual report for children enrolled in Medicaid/CHIP in the CMS children's annual reporting template system (CARTS); and provides periodic draft correspondence for the Director, Deputy Commissioner, Commissioner and Governor's signatures;
Develops, implements and ensures that performance metrics, health information technology and practice models are being implemented, tested, monitored and that children's health care quality is improved in collaboration with other DHSS Divisions, stakeholders and other states' Medicaid/CHIP agencies;
Directs Medicaid/CHIP Financial Management Services Division staff to enable completion of CMS federal enrollment reporting requirements and certifies the federal reports in the CMS online statistical enrollment data system (SEDS) for the DHSS.
Provides direction on the CMS children's quality measurement metric production and researches criteria, reports, approves and certifies the data for the DHSS in the CMS system, MACPro.
Leads the DHSS quality improvement initiative on patient experience of care/access to care in conjunction with the Division of Public Health, Women Children's Family Health Section and coordinates with practices and statewide stakeholder organizations on patient centered medical home (PCMH) utilizing the National Committee for Quality Assurance (NCQA) standards, methodologies and survey tools for practice recognition and designation that may be used to reward performance and can be used in Medicaid reform/innovation initiatives under the federal Patient Protection Affordable Care Act law.
Represents the Division, Department and State of Alaska before national and statewide stakeholder groups/organizations; provides children's policy guidance to Director's and Commissioner's Office for proposed legislation. The incumbent serves on the DHSS Medicaid Directors'/Division work group and other intra and interdepartmental workgroups.

The ideal candidate will possess the following Knowledge, Skills, and Abilities:
Knowledge of the Children's Health Insurance Program in Alaska, including the various providers and populations they serve;
Considerable knowledge of health care delivery systems, public and Medicaid programs, standards, regulations, terminology, policies, procedures, information systems, and operations at state and federal levels;
Experience interpreting and applying state and federal laws and regulations as they relate to the administration of Medicaid;
Experience presenting oral testimony, arguments or presentations, and experience representing the division's interests before high level policy groups, and in administrative hearings;
Excellent organizational skills, ability to set and manage competing priorities and meet deadlines, with strong attention to detail;
Excellent written and oral communication skills, including facilitation, negotiation and conflict resolution skills;
Excellent interpersonal relationships skills, with the ability to work collaboratively with internal and external stakeholders, and cooperatively with other divisions, agencies, and groups;
Ability to handle complex assignments with little supervision;
Strong understanding and application of continuous quality improvement process and principles;
Ability to analyze a major, complex component of the State's Medicaid programs, analyze complex state and federal guidelines, assess the impact of changes and propose regulations, policies and procedures to effect program implementation, including specialized Medicaid projects and initiatives.

To view the general description and example of duties for an
Medicaid Program Specialist IV please go to the following link:

One year of experience as a Medicaid Program Specialist III with the State of Alaska or the equivalent with another employer.


Seven years of any combination:
Post-secondary educational course work in public health, economics, public policy, legal studies, finance, business, or computer sciences from an accredited college (2.67 semester or 4 quarter hours equals 1 month)


Experience in health insurance administration, health insurance management information system, or health insurance finance and accounting; experience monitoring medical or public assistance programs for fraud or quality; experience conducting policy research and analysis; experience drafting health insurance policy; experience developing health insurance programs; experience examining medical claims, coding, billing, or patient information for reimbursement; or experience in a medical or healthcare field.

Certification as a Program Integrity Professional, Professional Coder, Professional Biller, Medicaid Professional, or other equivalent certification will substitute for one year of the required education and/or experience.

ADDITIONAL REQUIRED INFORMATION:At time of interview applicant must submit:
A copy of academic transcripts, to verify post-secondary education used to meet the minimum qualifications. (Unofficial are okay, please ensure that the institution/URL name is listed on the transcripts).
One technical writing sample. Examples: business memo, white paper, proposal, report or study results, process instructions, etc.
List of three professional references, including daytime telephone numbers. At least one must be from a current or former supervisor;
Copies of your three most recent performance appraisals. If unavailable, supervisory letters of reference may be substituted.

You're Knowledge, Skills and Abilities narrative will be considered a writing sample and will be used to determine which applicants will advance to the interview phase of the recruitment process. Please use complete sentences and proof-read your submissions when answering the supplemental questions.

To verify education being used to meet the required minimum qualifications, 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 being used to meet the minimum qualifications for a position and are required with each application. (Unofficial are okay, please ensure that the institution/URL name is listed on the transcripts). Transcripts can be attached at the time of application, provided at the time of interview, or if/when requested prior to scheduling an interview.

Education completed in foreign colleges or universities 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 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. Omission of required documentation listed will result in an incomplete application and you will not receive further consideration.

When using work experience not already documented in your application, please provide the employer name, your job title, dates of employment, and whether full-or part-time. Applications will be reviewed to determine if the responses are supported and minimum qualifications are clearly 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 in which you are applying.

If you are 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 there are minimum qualifications that 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 in its entirety. Noting "see resume or CV" or any similar response on any portion of your application may lead to a determination your application is incomplete and removal from consideration for this job posting.

The State of Alaska does not provide VISA Employer sponsorships.

This position is open to Alaska Residents only. Please check our residency definition to determine if you qualify.

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.

You can ONLY apply for this position through the Workplace Alaska website or via hardcopy application. If you accessed this recruitment bulletin through a job search portal such as ALEXsys or any other database, you MUST use a Workplace Alaska online or hardcopy application to successfully apply. Instructions on how to apply with Workplace Alaska may be found on the Workplace Alaska "How to Apply" webpage, found here:

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 your email address is correct on your application and that the spam filter will permit email from the '' domains. For information on allowing emails from the '' domains, visit the Lost Password Help page located at

The State of Alaska complies with Title I of the Americans with Disabilities Act (ADA).Individuals with disabilities, who require accommodation, auxiliary aides or services, or alternative communication formats, please call 1-800-587-0430 or 465-4095 in Juneau or (907) 465-3412 (TTY) 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.

For specific information in reference to the position please contact:

Name/Title: Lisa Myers/Administrative Officer II
Mailing Address:4501 Business Park Blvd. Suite 24 Anchorage, AK
Fax Number: 907-465-2204
Phone Number: 907-465-5827