What are the responsibilities and job description for the Medicaid/Medicare Services Specialist II position at Commonwealth of Kentucky?
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2/12/2025 (7:00 PM EST)
25-00537
Medicaid/Medicare Services Specialist II
Pay Grade
14
Salary
$41,942.48 - $62,928.48 Annually
Employment Type
EXECUTIVE BRANCH | FULL TIME | ELIGIBLE FOR OVERTIME PAY | 18A | 37.5 HR/WK
Click here for more details on state employment.
Hiring Agency
Cabinet for Health & Family Services | Department for Medicaid Services
Location
275 East Main Street
Frankfort, KY 40621 USA
The agency may authorize the selected candidate to telecommute. The agency may terminate or modify the telecommuting arrangement at any time.
Frankfort, KY 40621 USA
The agency may authorize the selected candidate to telecommute. The agency may terminate or modify the telecommuting arrangement at any time.
Description
The Department for Medicaid Services (DMS) provides health care access for eligible low-income residents of Kentucky including children, families, pregnant women, the aged and the disabled as well as a number of programs and services directed at specific eligibility and medical needs. DMS strives each day to meet the mission of the Cabinet for Health and Family Services to be a diverse and inclusive organization providing programs, services and supports that protect and promote the health and well-being of all Kentuckians and their communities.
The Department for Medicaid Services, Division of Program Integrity is responsible for guarding Medicaid against fraud, waste and abuse of program benefits by providers and members; ensuring that members receive necessary, and appropriate quality medical care; and assuring provider and member compliance with federal and state rules and regulations.
Learn more about us at: https://chfs.ky.gov/agencies/dms/Pages/default.aspx
Responsibilities include but are not limited to the following:
The Department for Medicaid Services, Division of Program Integrity is responsible for guarding Medicaid against fraud, waste and abuse of program benefits by providers and members; ensuring that members receive necessary, and appropriate quality medical care; and assuring provider and member compliance with federal and state rules and regulations.
Learn more about us at: https://chfs.ky.gov/agencies/dms/Pages/default.aspx
Responsibilities include but are not limited to the following:
- Organize and review records received from providers. Create and submit findings spreadsheet and findings letters once record reviews are completed.
- Disseminates program policy, procedures and other information to health care providers, recipients, management staff and others.
- Communicate with the designated staff to gather the appropriate information to run claims report data to conduct Medicaid provider and member reviews.
- Work with supervisor and other coworkers to develop skills and knowledge to read and interpret claims report details.
- Research complex issues in response to inquiries and prepares oral or written responses on department templates to communicate with providers, managed care organizations (MCOs), and other departments to obtain appropriate information required to complete records reviews.
- Communicate with Recovery branch to set up accounts receivables for completed audit overpayment recoupments and to set up any Dispute Resolution Meeting or Hearing requests.
- Attend and participate in Dispute Resolution Meetings or Hearings.
- Identifies changes needed to program regulations as the result of changes to federal or state statutes.
- Audits, reconciles, and identifies cases of potential Medicaid fraud, waste, or abuse and submits to supervisor.
- Attend and participate in meetings, hearings and trainings related to the Department for Medicaid Services.
- Participates in program Technical Advisory Committee (TAC) and Medicaid Advisory Committee (MAC) meetings and provides needed reports or information for the members.
- Perform other duties as assigned.
- Excellent verbal and written communication skills.
- Excellent computer skills, especially in Microsoft Office.
- Preferred candidate would have experience in the Medicaid systems.
- Ability to plan and establish priorities, differentiating between urgent, important and unimportant tasks.
- Excellent organization skills including time management, scheduling, coordinating resources and meeting deadlines.
- Attention to detail, being thorough and accurate in completing tasks.
- Ability to work under pressure, being able to cope with a high volume of work and meeting deadlines.
- Ability to work well with a team.
Minimum Requirements
EDUCATION: Graduate of a college or university with a bachelor's degree.
EXPERIENCE, TRAINING, OR SKILLS: Two years of experience in Medicaid or Medicare program administration, health insurance administration/systems, eligibility systems, health care research, health care planning, health care financial management, health care policy development, human service or health care administration, insurance billing and/or claims, or research, review, and analysis of legislation or regulations.
Substitute EDUCATION for EXPERIENCE: NONE
Substitute EXPERIENCE for EDUCATION: Experience in the above fields will substitute for the required college on a year-for-year basis. Current or prior military experience will substitute for the required college on a year-for-year basis.
SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.): NONE
Working Conditions
Incumbents working in this job title primarily perform duties in an office setting.
Probationary Period
This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.
If you have questions about this advertisement, please contact Keri Witherite at Keri.witherite@ky.gov or 502-229-7889.
An Equal Opportunity Employer M/F/D
Salary : $41,942 - $62,928
