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State of Montana Dental and Transportation Program Officer (11088) in Helena, Montana

/Women (and/or) minorities may be under-represented in this position and are encouraged to apply. / The Montana Department of Public Health and Human Services (DPHHS) currently has a great opportunity within theHealth Resources/Allied Health Servicesin Helena. At the Department of Public Health and Human Services, our mission is to improve and protect the health, well-being, and self-reliance of all Montanans. The department has four overreaching goals: * All Montana children are healthy, safe and in permanent, loving homes. * All Montanans have the tools and support to be as self-sufficient as possible. * All Montanans are injury-free, healthy and have access to quality healthcare. * All Montanans can contribute to the above through community service./ / Job Overview:The Health Resources Division seeks to provide health care for low-income and disabled Montanans through Medicaid, Healthy Montana Kids (HMK), and the HELP program (Montana Health and Economic Livelihood Partnership). As a Program Officer, this position is responsible for the Dental, Denturist, Orthodontia, Emergency and Non-emergency Ambulance, and Transportation (specialized non-emergency, commercial, personal mileage and per diem) Programs. Other responsibilities include working with the administrative rules, statutes, and policies concerning the claims payment system and coding; working with members and providers concerning services, billing, and case management; and coordinating program changes in the Montana Medicaid Information System (MMIS). Major Duties or Responsibilities Program Management * Develops and implements program health benefit coverage and reimbursement procedures based on state and federal Medicaid requirements, Administrative Rules of Montana (ARM), State Plan and other regulations. * Writes and updates administrative rules, statutes, and policies concerning claims payment methodology, billing, coding, and administration of benefits; and payment of services. * Develops, implements, and monitors attainment of program goals and objectives. * Conducts File Updates Requests (FUR), Customer Services Requests (CSR), and Project Change Requests (PCR), checks and approves system files for uploads, and makes recommendations for system changes based on federal changes, errors, etc. * Provides testimony on reimbursement rules and coverage when required at rule hearings, administrative reviews, and fair hearings. * Develops proposals for inclusion in the executive budget for approval and funding of new approaches to service delivery and reimbursement. * Communicates with stakeholders, providers, contractors, agents, other payers, federal agencies, and members, and resolves policy issues and reimbursement disputes. * Recommends comprehensive strategies to ensure the efficient operation of the program. Technical Oversight * Works with members and providers concerning services, billing, and case management. * Monitors program for waste, fraud, and abuse. Conduct preliminary investigations and reports suspected violations to law enforcement or other authority in accordance with federal and state statutes and regulations. * Serves as liaison to address coverage, reimbursement, or eligibility issues. * Maintains provider relations and information network through oral and written communications, including group presentations and meetings to ensure member access to services. * Develops assessment tools such as reports, spreadsheets, queries, etc. and reviews paid claims data, denied claims, and utilization of services to ensure program quality and compliance. * Represents the bureau and actively participate as a subject matter expert for department data and claims processing systems. Provides input and feedback for design of the new systems such as necessary features and display requirements and functionality tests. * Participates in medical coverage reviews, setting of medical procedure limits, and determination of medical necessity. * Compiles, develops, researches, and evaluates innovative alternatives and options to current benefit design, health care coverage, and policy. * Documents justification considering impact on Medicaid, other state agencies, other payers, federal government, members, providers and the public. Contract Management * * Writes requests for proposals (RFP’s), contracts and contract amendments. * Monitors and enforces contract requirements by writing notices and reviewing reports. * Ensures timely payment to the contractor for services rendered and submits approved bill to fiscal staff. * Monitors contractor performance of Prior Authorization reviews, etc., with contract compliance and writes corrective action plans as needed. * Performs cost benefit analysis prior to issuing RFPs and contract renewals to ensure need or continued need of service. Physical and Environmental Demands:Work is performed in a typical office environment with keyboarding responsibilities. In-state travel 5% of the time. Knowledge, Skills and Abilities (Behaviors) Required for the_first day of work_ * General knowledge of Medicaid and medical terminology. * Knowledge of program management principles and practices. * Ability to analyze math calculations. * Expertise in spreadsheet software (Excel) * Excellent interpersonal and customer service skills. * Excellent written and verbal communication skills. * Ability to interpret and apply laws, rules and regulations. * Ability to identify and solve problems. * Knowledge and understanding of large databases including manipulation of data and the impact of changes. Minimum Qualifications (Education and Experience) * Bachelor’s degree in human services; business, public, or health administration; or other related fields. * Two years of job-related work experience in health policy, health program development, or health administration. * Other combinations of directly related education and experience may be considered on a case-by-case basis. * Relative experience in the healthcare service delivery system, or healthcare coding certification is preferred. /To be considered for this position, please submit the following materials online through the State of Montana Careers site:/ * Cover Letter * Resume-Please include dates of employment and your Supervisor’s name/phone number for each position * Supplemental Question o What interests you most about this position and how would hiring you benefit the State of Montana? Please limit your answer to no more than one page. /To be considered for any DPHHS Agency position, applicants must complete and submit their application online, as well as upload any required application materials. Successful applicant(s) are required to successfully pass all DPHHS specific background check(s) relevant to each position./ Job: Project/Program Management* *Title: *Dental and Transportation Program Officer (11088) Location: Helena Requisition ID: 21142433

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