Medicaid Billing Reentry Demonstration Project/Program Manager II

Full Job Description

The Community Health Services Division of Public Health — Seattle & King County is seeking interested applicants for a Term-Limited Temporary or Special Duty Assignment as a Medicaid Billing Reentry Demonstration Project/Program Manager II.

We are seeking a qualified project manager to be responsible for identifying and completing the necessary steps for Jail Health Services (JHS) and Department of Adult and Juvenile Detention (DAJD) to successfully submit claims and receive reimbursement for Medicaid covered patients via the Epic Resolute billing system. The position requires working knowledge of local, state and federal billing requirements, including third party payers. The incumbent must have experience using an automated patient management system, including billing and practice management systems. The work environment is fast-paced and flexible. Our Team is a close-knit group that works together in troubleshooting claims and denials in Epic Resolute. This is an opportunity to work with a fun and positive team and provide healthcare services to the most vulnerable populations.

Temporary opportunity. Term-Limited Temporary (TLT) positions are "at-will" positions that are eligible for benefits. This TLT is currently anticipated to last for up to 18 months.

However, funding sources for this work remain uncertain and dependent upon decisions actively being made at both the federal and local levels.

As a result, the end date of this position may be adjusted based on those decisions. The County and the Department continue to work to secure long-term funding sources.

This vacancy can also be filled as a Special Duty opportunity.

For Special Duty Assignment (SDA) interest, you must be a Career Service, Career Service Exempt or other regular (non-temporary) employee in King County who has completed their initial King County probation.

You must have supervisor approval prior to taking a Special Duty Assignment.

This posting will create a list of qualified candidates that may be considered for selection of additional vacancies of the same position type over the next 6 months.

Position Summary

As the Medicaid Billing Reentry Demonstration Initiative Project/Program Manager II (PPM II), you will support the planning and implementation phases of King County's participation in the Reentry Demonstration Initiative, a new Apple Health (Medicaid) initiative under the Medicaid Transformation Project (MTP).

It provides essential, health care services for individuals leaving incarceration.

Under this initiative, incarcerated individuals who are Apple Health-eligible will receive a set of services up to 90 days before their release.

Additionally, youth in juvenile detention are further covered under the Consolidated Appropriations Act of 2023. These services will ensure a person’s health and successful reentry to their community.

The PPM II position is part of the Business and Revenue Unit (BRU) that is responsible for the medical, dental and behavioral health billing in Epic Resolute and provides training/support of the Epic Practice Management system to the Public Health Division’s 13 main clinic locations throughout King County, 3 School Based Health Centers, and many satellite/mobile units. The Business and Revenue Unit is expanding to include billing services for JHS and DAJD under the Reentry Demonstration Initiative. Our unit is responsible for maintaining the Epic Resolute (billing) system, enrolling billable providers in contracted health plans, reviewing individual charges, and processing claims and denials to maximize patient revenue. We also provide Epic Practice Management training and support for the front desk staff at the public health clinics.

Background

Community Health Services (CHS) is the largest of 7 divisions in Public Health– Seattle & King County with over 600 employees and an annual budget of $190 million for 2026-2027. Approximately 70,000 clients receive health services annually through the programs, partnerships, and Public Health Centers we operate. The purpose of CHS is to assure that basic health and human services are available to the most vulnerable people in King County. We also assure access to quality services through partnerships and regional programs. We are a Healthcare for the Homeless (HCHN) Health Resources and Services Administration (HRSA) grantee and a federally qualified health center, providing services to people experiencing homelessness, recent immigrants and refugees, people with medical and behaviorally complex conditions, and people with limited English proficiency. Our direct services include an array of parent child health programs, family health, refugee screening, travel immunizations, dental, and family planning. Our Title X Family Planning provides the full range of family planning services, including pregnancy options counseling and referrals for prenatal care, pregnancy termination or adoption services. Our direct services are located throughout King County and offered at eleven public health centers, in centers where we are co-located with other providers, school-based health centers, and through our mobile medical vans.

Public Health – Seattle & King County ("PHSKC", "Public Health", or "the department") is the Public Health Department for King County, Washington which includes 39 cities, including the City of Seattle, and unincorporated areas. Public Health is one of the largest metropolitan health departments in the United States with over 1,600 employees. With a biennial budget of nearly $1 billion, the department serves approximately 2.3 million people of King County who reside in urban, rural, shoreline, foothill, and mountain communities with distinct environments and unique public health needs. We operate primary care, dental, sexual and reproductive health, parent child health, and other health care-related services throughout King County across 40 sites and mobile clinics. King County is an international port of entry, welcoming nearly 40 million visitors annually. Over 100 languages are spoken by King County residents.

Commitment To Equity and Social Justice
Named after Dr. Martin Luther King, Jr., one of the most influential civil rights leaders in our nation's history, King County is a vibrant international community with residents that represent countries from around the world. It is a region with increasing diversity that cherishes the traditions of many cultures.

The county government has a deep commitment to equity and social justice and advancing practices, strategies, and policies that promote fairness, justice, and opportunity for all – in our workplaces and our communities. With this commitment, King County has adopted a pro-equity agenda to advance regional change and ensure that residents from all communities are incorporated into our emergency planning and public outreach efforts.

We recognize that structural racism consists of principles and practices that cause and justify an inequitable distribution of rights, opportunities, and experiences across racial groups. Since declaring Racism is a Public Health Crisis in June 2020, King County and Public Health committed to being intentionally anti-racist and accountable to Black, Indigenous and People of Color communities.

To learn more, please visit: http://www.kingcounty.gov/elected/executive/equity-social-justice.aspx.

Work Schedule
The typical work week is Monday through Friday, 8:00am-5:00pm, 40 hours per week with some flexibility within those business hours as approved by your supervisor. This position is designated as hourly/non-exempt under the regulations of the Fair Labor Standards Act (FLSA), which means it is overtime-eligible. You must receive prior approval from your supervisor before working any necessary overtime hours to meet your position responsibilities. Our employees are paid on a bi-weekly schedule, every other Thursday.

Work Location
Chinook Building – 401 Fifth Avenue, Suite 1000, Seattle, WA 98104

Remote and Onsite Work

The Business and Revenue Unit works in a hybrid model, with days in the office as well as telecommuting. The ratio of remote to onsite work will be dependent on business needs and is subject to change.

Current expectations are that employees work a minimum of 2 days in-person per week, with an increase to 3 days in-person per week by June 1, 2026.

Employees must reside in Washington state and within a reasonable distance to their King County worksite to respond to workplace reporting requirements.

King County has a robust collection of tools and resources to support working remotely.

The individual selected for this opportunity will join an innovative and progressive team that is redefining how we work as we transition to the department's hybrid environment.

Employees will be provided with a County-issued laptop and must maintain a home workspace with an internet connection where they can reliably perform work and remain available and responsive during scheduled work hours.

Working Condition
(DAJD requirement) Necessary Special Requirements: The selected candidate for this position will be required to complete a comprehensive background investigation, which includes fingerprinting, a criminal history check, reference checks, and a pre-employment physical (if applicable).

Requirements

• Overall project management duties related to scope of work including developing a schedule/project plan, gathering data and performing analysis, producing status reports, and developing recommendations.
• Assist with interpretation of state and federal billing requirements to assure compliance and optimal revenue, including the Centers for Medicare and Medicaid Services, the Washington State Health Care Authority, and contracted managed care organizations.
• Coordinate Medicaid billing requirements with staff including clinical, program and project staff across Departments and Divisions.
• Ensure all billable providers are built in the Epic master file and enrolled with all managed care plans and in ProviderOne.
• Assist with developing steps for automated batch reporting on patient eligibility and updating coverage information in patient registration.
• Develop recommendations to research and resolve guarantor and pended claims.
• Identify relevant CPT, HCPC, and ICD10 codes for services provided and coordinate building fees and necessary clinical documentation so that services and fees flow to Resolute for billing. Consult on coding questions with certified coder as needed.
• Provide recommendations for edits and work queues to ensure billing/revenue requirements are met in an electronic (EHR) environment.
• Provide analyses/recommendations to ensure billable encounters and billing requirements are met.
• Monitor initial billing activity to ensure success including processing charges and claims; monitoring accounts receivable and resolving aging accounts; analyzing, researching and resolving outstanding and/or denied claims.
• Provide initial training and support for patient registration as needed.
• Perform other duties as assigned.

Qualifications

Our ideal candidate will demonstrate the following (Minimum Qualifications):

• Experience using ICD10, CPT and HCPCs codes for billing.
• Desired Certifications includes one or more of the following:
  • American Academy of Professional Coders (AAPC) Certifications: Certified Professional Coder (CPC or CPC-A)
  • American Health Information Management Association (AHIMA) Certification: Certified Coding Specialist (CCS)

Additional Information

To ApplyIf you are interested in pursuing this position, please follow the application instructions carefully.

If you need this announcement in an alternate language or format, would like to request accommodation or assistance in the application or assessment process or if you have questions, please contact the recruiter listed on this job announcement.

Who May Apply

We welcome applications from all qualified applicants. We value diversity, diverse perspectives, life experience, and encourage people of all backgrounds to apply.

Application Process

The following items are required to be considered for this vacancy:

• NEOGOV Job Application (The responses on your job application should be thorough and complete and will be used in the screening process)
• Supplemental Questions (The responses to the supplemental questions should be thorough and complete and will be used in the screening process)

(Please note: Cover letters, resumes, and additional attachments will not be reviewed as part of the evaluation process if not outlined as a required application material as outlined above).

Your application may be rejected as incomplete if you do not include the relevant information in your application. Cover letters and/or resumes are not accepted in lieu of a completed application.

Applications and/or Supplemental Questionnaires that state "see my resume" or "see my personnel file" are considered incomplete and will not be accepted.

ContactIf you have questions or would like more information about the application process, please contact Falisha Forgash, HR Analyst at fforgash@kingcounty.gov.

Union Membership This position is not represented by a labor union. Necessary Special Requirements

• The selection process may include evaluation of application materials and supplemental questions, interviewing, and testing. You must completely fill out the application with your relevant education and work experience.
• The selected candidate must be able to provide proof of Basic Life Support (BLS)/CPR. (if applicable)
• The selected candidate must be able to pass a thorough background investigation and Pre-employment Physical, but findings may not necessarily disqualify an applicant for employment. (if applicable)
• For more information on our selection process, please refer to www.kingcounty.gov/depts/health/jobs/hiring. For tips on interviewing, please visit https://www.kingcounty.gov/~/media/audience/employees/learning-and-development/Interview_Tips.ashx?la=en.
• Employees are required to protect the privacy and security of protected health information as defined in State and Federal Law.
• Public Health – Seattle & King County relies on office automation (Microsoft Office) and web-based enabled tools, therefore candidates must be proficient and comfortable with computer use to perform functions associated with on-going work.
• Employees are required to adhere to OSHA/WISHA guidelines including but not limited to completing their mandatory trainings on time and obtaining required immunizations.
• Regular and reliable attendance, effective communication skills, and development of effective working relationships are requirements of all Public Health – Seattle & King County positions.

When Public Health responds to an emergency, and in accordance with relevant CBA language and/or KC policy and procedures, we may assign duties outside your regular job description.

This may involve responding at any time, including nights and weekends, with possible deployment to locations other than the department.

• If you need a disability accommodation in the application or testing process, please call the contact number listed on the job announcement.

Forbes recently named King County as one of Washington State's best employers.

Together, with leadership and our employees, we're changing the way government delivers service and winning national recognition as a model of excellence. Are you ready to make a difference? Come join the team dedicated to serving one of the nation's best places to live, work and play.

Guided by our "True North", we are making King County a welcoming community where every person can thrive. We value diversity, inclusion and belonging in our workplace and workforce.

To reach this goal we are committed to workforce equity.

Equitable recruiting, support, and retention is how we will obtain the highest quality workforce in our region; a workforce that shares and will help advance our guiding principles--we are one team; we solve problems; we focus on the customer; we drive for results; we are racially just; we respect all people; we lead the way; and we are responsible stewards.

We encourage people of all backgrounds and identities to apply, including Native American and people of color, immigrants, refugees, women, LGBTQ+, people living with disabilities, and veterans.

King County is an Equal Employment Opportunity (EEO) EmployerNo person is unlawfully excluded from employment opportunities based on race, color, religion, national origin, sex (including gender identity, sexual orientation, and pregnancy), age, genetic information, disability, veteran status, or other protected class.

Our EEO policy applies to all employment actions, including but not limited to recruitment, hiring, selection for training, promotion, transfer, demotion, layoff, termination, rates of pay or other forms of compensation.