Tribal Billing Program Specialist (PS3/OTA)

Job title:

Tribal Billing Program Specialist (PS3/OTA)

Company

Washington State

Job description

DescriptionTribal Billing Program Specialist (PS3/OTA)71107538Are you passionate about improving healthcare for Tribal communities? Join us as a Tribal Billing Program Specialist, where you’ll play a key role in supporting Medicaid claims operations and maintaining government-to-government relationships with Tribal nations and the Indian Health Service (IHS). You’ll provide technical assistance, training, and guidance on claims submissions, system adjudication, and Tribal billing trends. This role offers the opportunity to collaborate across state and Tribal entities, ensuring compliance with Medicaid rules and advocating for Tribal health issues. With telework flexibility and comprehensive benefits, this position is perfect for someone with strong analytical skills, experience in claims processing systems, and a dedication to serving Tribal communities. Apply today and make a meaningful impact!All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.About the division:Functioning as both the state’s largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible. There are three pillars to our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.About the position:The purpose of the OTA Tribal Billing Tech (Program Specialist 3) is to support the agency’s requirements under Chapter 43.376 RCW by establishing and maintaining a government-to-government relationship with Tribal nations and serving as a Tribal liaison. This delegation, from the Tribal Affairs Administrator (the agency’s Tribal liaison under RCW 43.376.030), extends to the Indian Health Service (IHS) and Tribal governments in connection with federal and state rules on Medicaid claims submissions and system adjudication. The position also serves as a Tribal liaison for this purpose. Additionally, the position supports the OTA Program Specialist 4 and the Medicaid Operations and Compliance Manager for IHS, Tribal health care programs, urban Indian health programs, and other Indian health programs (collectively, Indian Health Care Providers or IHCPs). This position plays a key role in providing support to both internal and external parties for ProviderOne technical questions, billing assistance, and information dissemination. The work is specifically intended to help Tribes, HCA staff, and MCOs navigate the unique government-to-government relationship that Tribal nations have with the State of Washington.This position is eligible to telework but is required to report on-site for initial training or to meet occasional business need. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.DutiesSome of what you will do:

• Maintain government-to-government relations with IHS and Tribes regarding MMIS and Medicaid (including managed care) claim submissions and adjudication rules and processes.
• Maintain positive working relationships with IHCPs on Medicaid claims operations, including claims submission and adjudication, as part of government-to-government partnerships with IHS and Tribes.
• Provide consultation and training to IHCPs regarding Medicaid claims submission rules and system requirements for claims processing and adjudication.
• Interpret and administer agency policies, procedures, and practices for IHS and Tribal health program Medicaid claims, specifically for the IHS encounter rate.
• Provide consultation and coordinate communications with IHS, Tribal health care facilities, and non-Tribal Indian health care providers to educate and promote federal agency rules for IHS encounter rate claim submission and claims processing system rules.
• Triage IHCP operations and implementation issues by utilizing HCA program staff expertise and develop recommendations for correction or mitigation.
• Manage and monitor daily operational issues related to IHS and Tribal health.
• Monitor agency and IHS/Tribal compliance with Medicaid IHS encounter rate rules.
• Provide ProviderOne technical support and recommend solutions for complex problems.
• Monitor IHCP compliance with claims submission requirements and offer technical assistance to improve compliance.
• Monitor MMIS and MCO compliance with claims adjudication requirements and offer technical assistance to internal staff to enhance system compliance.
• Provide technical assistance and recommend solutions for Program Integrity staff and external auditors regarding Medicaid IHS encounter rate rules.
• Prioritize access to care by triaging issues to the appropriate channels within HCA.
• Independently triage and respond to IHCP questions.
• Manage contact lists and the ServiceNow ticketing system for the Office of Tribal Affairs

QualificationsRequired qualifications:Qualifying candidates will meet one of the following criteria options:Option 1:Bachelor’s degree in public administration, business administration, accounting, computer programming, or a closely related field, and two (2) years of the required experience belowOption 2:Six (6) years of the required experience belowThe required experience includes the following:

• Supervisory or consulting experience in health care revenue management, Medicaid program financial administration, or financial system programming or administration.
• Competent in utilizing the Microsoft Office software suite.
• Familiar with Washington Tribal culture and skilled in working with Tribes while practicing cultural humility.
• Knowledge of healthcare claims preparation (including coding), submission, adjudication, correction, and reconciliation.
• Knowledge of computer system adjudication of claims.
• Knowledge of federal and state Medicaid claim rules.
• Skilled in communicating and articulating ideas, problems, and solutions orally in a clear and concise manner over the telephone, during presentations, in meetings, and through written communication.
• Proficient in logical and abstract thinking to identify issues and formulate resolutions.
• Knowledge of Indian Health Service programs and policies as they impact Medicaid.
• Capable of reviewing federal and state statutes, regulations, and potential legislation and policies, including evaluating complex issues arising from policy changes or legislative mandates.
• Experienced in collaborating with state agency administrative staff, assistant attorneys-general and legal staff, clients, and client representatives.
• Adept at working collaboratively with internal agency staff, agency liaisons, Tribal representatives, Tribal consortia, Tribal consultants, IHCPs, Tribal health directors, and Tribal councils.
• Proficient in analyzing policy, researching issues, identifying impacts, assembling documentation, writing policies and policy briefs, and representing HCA’s Tribal program position.
• Able to maintain ethical boundaries between advocacy for Tribal issues, policy needs, and agency limitations.

Preferred qualifications:

• Knowledge of the agency’s MMIS and/or a health insurance company’s claims processing system.
• Communicate Tribal-identified issues to the appropriate program or administrative office.
• Monitor and analyze Tribal facility compliance and Tribal billing trends.
• Evaluate the need for and provide technical assistance/training to executive leadership, program managers, and internal staff on Tribal policy.
• Work independently with minimal supervision.

How to apply:Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference, please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.

Supplemental InformationAbout HCA:Functioning as both the state’s largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve
• A clear agency mission that drives our work and is person-centered
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• Tuition reimbursement
• And free parking!

Notes:Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at . Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Lisa Fleming at (360) 725-1723 or .The Washington State Health Care Authority (HCA) is an . All applicants with a in the United States are encouraged to apply.E-Verify® is a registered trademark of the U.S. Department of Homeland Security.to receive a list of new job postings at HCA.

Expected salary

$56880 – 76608 per year

Location

Olympia, WA

Job date

Fri, 01 Nov 2024 05:38:12 GMT

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