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Medicaid Contract Specialist

4 months ago

Salem, United States PacificSource Full time
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Under limited supervision, assist Medicaid Administration staff in ensuring organizational adherence to contractual requirements with the Oregon Health Authority, external entities, providers, payers, and other states, as applicable. Employ an effective and efficient organizational skill set to coordinate department needs. Coordinate PacificSource activities to ensure contract deliverables are reviewed, compliant, and submitted timely. Works closely with CCO leadership and other stakeholders, contract management support, schedules, timelines, and review processes. Provide support on critical work groups to track and document contract changes. This role interacts with internal and external stakeholders and partners.

Essential Responsibilities:
  • Develop and maintain effective solutions and processes to manage schedules, timelines, activities, and milestones for Medicaid contract deliverables and reports for multiple CCOs. This includes all Medicaid contract types; CCO contracts with the Oregon Health Authority, Cover All Kids, and Choice Model Services, across multiple service areas where PacificSource has contracts of this type.
  • Coordinate and collaborate with leadership and key stakeholders to ensure timely, accurate, and complete submissions of 170+ State deliverables per CCO, on an annual basis, consistent with PacificSource standards. This volume is subject to change with each contract cycle.
  • Manage the deliverable process with internal and external stakeholders to improve the quality and integration of deliverable content.
  • Ensure all state and federal guidance related to deliverables and reports is current and distributed to internal stakeholders that are accountable for the deliverable.
  • Using independent judgement, provide a final review (before submission to Medicaid Administration leadership for final submission) of all contract deliverables and reports (including the redaction process) to ensure compliance with requirements, guidance, and use of state templates. This review includes, but is not limited to, ensuring a consistent voice for each service area, content review, grammar and punctuation accuracy and consistency, and branding of final documents.
  • Document, store, and manage final submission materials.
  • Coordinate with and support internal and external stakeholders to provide a resource for contract questions, interpretations, expectations, and requirements.
  • Attend State meetings and work groups, as applicable.
  • Maintain a current working knowledge of applicable Medicaid rules and regulations.
  • Provide support for aligning Medicaid contract activities in each CCO region.
  • Maintain collaborative partnerships with key PacificSource departments and leaders.
  • Assume a supporting role in working with providers, the State, and other partners.
Supporting Responsibilities:
  • Perform day-to-day tasks for the Medicaid Administration department as needed.
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.
Work Experience: Minimum three years of experience in the health care, managed care, or public health administration industry and/or equivalent experience required. Relevant knowledge in the following areas preferred: the Oregon Health Plan, health care operations, and demonstrated organizational skills.

Education, Certificates, Licenses: Bachelor degree in Business Administration, Health Administration or other related field or a combination of equitable work and education experience required. Certificates in Business Administration or Technical Writing preferred.

Knowledge: Excellent organizational skills demonstrating efficient documentation methods. Demonstrated successful communication and interpersonal skills. Ability to be nimble in a fast-paced environment with competing deadlines. Demonstrated skills with the following software: Microsoft Office Suite (e.g. Outlook, Word, Excel, PowerPoint, and Visio), Adobe or Foxit PDF software, and SharePoint.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is possible approximately 10% of the time.

Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.


Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.