Medicaid Program Specialist 3 (Surveillance Utilization Reviewer)

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 Surveillance Utilization Reviewer, you will ensure regulatory compliance by conducting Department-wide Surveillance and Utilization Review (SURS) activities, including in-depth claims research and data analysis. Your role involves establishing service review criteria, identifying billing irregularities, and recommending corrective action plans. Additionally, you will provide education, industry standards, and regulatory guidance to healthcare providers while evaluating clinical documentation against all Federal and State regulations.

You will also prepare detailed investigative reports and provide expertise in CPT and HCPCS coding to ensure proper claims submissions. Collaborating with Department partner agencies and State contractors, you will support the identification of aberrant provider behavior and maintain the accuracy of exception reports through data evaluation.

Our organization, mission, and 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:

•

A

rticulate

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C

ompetent

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C

onstructive

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E

thical

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S

trategic

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S

incere

If you are someone who embraces these values and wants to assist in the mission of HCS, we encourage you to apply today.

The benefits of joining our team:

We are a dynamic, diverse, high-performing team that focuses on excellent customer service and accuracy. The incumbent will work with a team of highly dedicated, hardworking individuals committed to ensuring the health, well-being, and safety of our vulnerable population. The work environment is positive, professional, constructive, and detail-oriented. This role also works closely with federal oversight partners, providing meaningful, high-impact experience.  In addition, the team supports work-life balance through a flexible hybrid schedule with 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. Employees are on a telework rotation and receive an assigned parking space for convenience.

Who we are looking for:

The ideal candidate will possess some or all of the following position-specific competencies in addition to the minimum qualifications listed below:

Writing

: Recognizes or uses correct English grammar, punctuation, and spelling; communicates information (for example, facts, ideas, or messages) in a succinct and organized manner; produces written information, which may include technical material, that is appropriate for the intended audience.

Self Management:

Sets well-defined and realistic personal goals; displays a high level of initiative, effort, and commitment towards completing assignments in a timely manner; works with minimal supervision; is motivated to achieve; demonstrates responsible behavior.

Decision Making

: 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.

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 3

:

https://www.governmentjobs.com/careers/Alaska/

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