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Program Specialist II (PA2012CC)

Health Care | Harrisburg, PA | Full Time and Part Time

Job Description

Program Specialist II

Seeking qualified full-time and part-time Program Specialists to provide services to the Division of Managed Care Systems Support (DMCSS) in Harrisburg PA. The position offers a structured schedule which allows for a great work/life balance all while servicing your local government and making a difference in your community.

POSITION SUMMARY

The DMCSS Program Specialist 2 will assist with the development, maintenance, and evaluation of data systems and procedures designed to support managed care programs (i.e. HealthChoices and Community HealthChoices) administered by the Office of Medical Assistance Programs.  This may include working with managed care organizations (MCOs) for the submission of encounter data, monitoring of the systems portion of the contracts with the MCOs, monitoring of capitation and maternity care payments made to MCOs, and verifying managed care eligibility.

POSITION REQUIREMENTS

  • Bachelor’s Degree or equivalent experience
  • At least 2 years of healthcare industry experience, preferably with a health plan required
  • Proficiency in Microsoft Office Suite, including Access, Excel, PowerPoint and Word required
  • A working knowledge of healthcare operations preferably: customer service, claims/capitation processing, HIPAA 837, 835, 820 and NCPDP transaction sets, encounter submissions, contract monitoring, or enrollment
  • Applied analytical skills
  • Strong written and verbal communication skills
  • Proven ability to successfully complete both short and long-term assignments
  • Ability to lead meetings and/or presentations
  • A working knowledge of Medicaid/Medical Assistance preferred

POSITION RESPONSIBILITIES

  • Reviews 837 and NCPDP encounter file submissions to assist MCOs in passing edits and audits within the Department’s MMIS (PROMISe).
  • Performs retrospective data reviews to ensure data quality of system contract requirements have been achieved.
  • Monitors and validates the accuracy of payments made to MCOs, as well as MCO excluded services.
  • Responds to inquiries relating to encounter submissions, systems contract monitoring requirements, and payments made to MCOs that are submitted through public email boxes.
  • Reviews, analyzes, and recommends revisions to existing and proposed policies, regulations, and procedures.
  • Other related duties as required.

We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.