Summary

This job involves managing and processing health care data submissions from managed care plans in Michigan's Medicaid program, ensuring the data is accurate and compliant to help monitor care quality and support program decisions.

The role includes communicating with stakeholders, testing data systems, and analyzing large datasets for issues.

It's a good fit for someone with a background in health care data handling, strong analytical skills, and experience in government or managed care environments.

Key Requirements

Possession of a bachelor’s degree in any major
Experience processing and monitoring managed care encounter data
Ability to communicate data requirements to internal and external stakeholders
Skills in analyzing test data and approving production submissions
Proficiency in planning and overseeing data submission changes due to regulations like HIPAA or ACA
Experience developing and executing user testing scenarios in systems like CHAMPS
Ability to create ad-hoc queries using Bi-Query software for data analysis and compliance monitoring

Full Job Description

The Michigan Department of Health and Human Services mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit MDHHS Diversity Equity and Inclusion.

This position serves as the specialist in the Managed Care System Operations section.

With assistance from a Departmental Analyst, directs functions related to the processing of managed care encounters.

These encounters are used to monitor the quality of care by the health plans and provide data for managed care rate setting, research projects, case management studies, and other requested data extracts; they support the Department is assessing the effectiveness of Medicaid managed care programs.

With assistance from a Departmental Analyst, monitors the submission of data from many different types of managed care health plans on a statewide basis; communicates encounter requirements to both internal and external stakeholders; analyzes test data from the managed care entities and granting approval for submission of production encounter data; plans and oversees changes in data submission due to program additions or modifications, new HIPPA or ACA regulations, and/or department initiatives.; develops and executes user testing scenarios related to encounters in CHAMPS as defects are fixed and enhancements are instituted; and creates ad-hoc queries using Bi-Query software in the Data Warehouse to analyze and monitor large sets of encounter data for compliance and accuracy.

Position Description

Job Specification

To be considered for this position you must:

apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
relevant experience and/or education referred to in supplemental questions must be documented in resume, transcript and/or application to allow for accurate screening.
attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
attach a cover letter.

if applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts.

Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature.

Failure to complete any of the above items may result in your application not being considered. See instructions for attaching files here: Instructions

Requirements

Education

Experience

Departmental Specialist 13

Additional Information

The physical location of this position is 400 S. Pine Street, with remote options available. Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered.

Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.

Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:

A secure work location that allows privacy and prevents distractions.
A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
Suitable lighting, furniture, and utilities.

MDHHSVacancies@michigan.gov