State of Montana Medicaid Program Officer (31012) in Helena, Montana

/ 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. /

Materials Required of Applicants:

(To be considered in this pool, please submit the following)

  • Resume

  • Professional References:

o Please provide 3 professional references, work relation, and contact number

  • Supplemental question(s):

o In two pages or less, describe your experience with program management. Include any relevant experience with Administrative Rules of Montana, contract management, and interpretation and implementation of Federal Rule. Additionally, include any experience with Medicaid or other healthcare programs.

(Please type responses in a Word document and attach to application. HELPFUL HINT: When attaching a document you must check the “relevant document” box to ensure your attachments are uploading correctly to the specific application. Please do not attach more than requested. If you have more than 25 attachments in the system you will need to email these to: hhshumanresources@mt.gov . Failure to attach the required material will conclude in an incomplete application. You must also keep those relevant boxes checked once you submit your application; if you uncheck the box with an active application it will delete the attachment.)

Job Overview:

This position is located in the Children’s Mental Health Bureau (CMHB), in the Developmental Services Division (DSD), at the Department of Public Health and Human Services (DPHHS). The Medicaid Program Officer is responsible for developing and monitoring youth mental health programs and services such as inpatient psychiatric care, psychiatric residential treatment facilities (PRTF), therapeutic group home, partial hospital programs, home support services, therapeutic foster care, targeted case management services, comprehensive school and community treatment (CSCT), outpatient psychotherapy , day treatment, and community based psychiatric rehabilitation and support (CBPRS).

Essential Functions (Major Duties or Responsibilities):

Program Development

  • 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 regulatory bodies.

  • Provides testimony on reimbursement rules and coverage when required at rule hearings, administrative reviews and fair hearings.

  • Communicates with stakeholders, providers, contractors, agents, other payers, federal agencies, and clients and resolves policy issues and reimbursement disputes. Solicits feedback from providers to identify problems and necessary changes.

  • Writes and updates administrative rules, statutes, and policies for programs administered to include billing, coding, and administration of benefits and payment of services. Assists the Department with possible fraud, waste, and abuse cases.

  • Works with utilization contractor and licensing to review quality of service and adherence to administrative rules and federal regulations.

  • Participates in research, preparation, or collaboration for upcoming grant (or alternative) funding opportunities.

  • Researches and applies federal rules, policies, and directives and proposes changes that impact assigned mental health services, including researching best practice models for mental health services and comprehensive strategies to ensure the efficient operation of the program.

  • Participates in developing payment methodology for assigned mental health services, evaluates these rates as they relate to access, provider costs, and effective service, and considers any proposed alternatives.

Program Operation

  • Prepares File Updates Requests (FUR), Customer Service Requests (CSR), checks and approves system files for uploads and makes recommendations for system changes based on federal changes, errors, etc.

  • Maintains provider relations and information network through oral and written communications, including group presentations and meetings to ensure patient 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 participates 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, clients, providers and the public.

  • Implements and reviews quality indicators and completes quality assurance reviews.

  • Participates in administrative reviews, fair hearings, and audits as necessary. Assist the department with possible fraud/abuse cases.

Contract Management

  • Performs contract management for services obtained contractually by the (CMHB), including Utilization Review and grant disbursements. Management of contracts includes Request for Proposal (RFP) development, performance management, and contract amendments.

  • Collaborates with utilization contractor to conduct site visits and completes quality assurance checks.

  • Reviews submitted contractually required reports, as well as any ad hoc contractual correspondence from contractors, and provides high-level summary analysis and recommended action items to management.

  • Liaison between CMHB and any contractors, including implementation guidance, contract management, payment disputes or questions, or other related issues.

  • Works with Department staff across divisions on any collaborative contracts.

Other Duties as Assigned

Physical and Environmental Demands:

Typical office environment with keyboarding responsibilities. Occasional in-state travel with advance notice (up to 10%).

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.

  • Excellent written and verbal communication skills.

  • Critical thinking and problem-solving skills.

  • Excellent interpersonal and customer service skills.

  • Ability to interpret and apply laws, rules and regulations.

  • Ability to operate a personal computer and general office equipment as necessary to complete the essential functions, including using spreadsheet, word processing, database, email, internet and other computer programs.

Required Minimum Education and Experience:

  • Bachelor’s degree in business, healthcare administration, human services (including counseling or social work) or related field.

  • Two years of work experience in program management, preferably healthcare related.

Job: *Business/Analyst/Statistics

Title: Medicaid Program Officer (31012)

Location: Helena

Requisition ID: 18142855