Program Consultant II (209572)

Job Description and Responsibilities:

The Kansas Department of Health and Environment has a Program Consultant II opening in Topeka. This position will be responsible for Claims and Encounter Data Projects, reviewing all project related documents, reviewing, and providing input, working with sister agencies, making decisions regarding changes and design specifications that would affect claims and encounter data processing, and attending and participating in all project related meetings.

Job Responsibilities may include but are not limited to the following:

• Managed Care – Claims and Encounter Data Management, Oversight and Compliance Monitoring:
• Provide guidance and direction on the submission of claims and encounter data processing by performing the following:
  • Act as Liaison between contractors.
  • Coordinate and perform audits on claims and encounter data
• Review reports to ensure timely and compliant claims and encounter data has been submitted:
  • Reviewing proposed edit and audit changes
  • Developing State requirements and standards
  • Conducting trend analysis on submitted data
• Participate in or facilitate various meeting involving claims processing or encounter data.
• Review publications as necessary.
• Work with the contractors on remediation or corrective action plans when necessary.
• Review processes to ensure they are in compliance with their contract, including but not limited to Front End Billing.
• Direct the activities related to the management of the claims, corrected claims, claims reprocessing and encounter claims inventory
• Work with KDHE, sister agencies or KDHE contractors in monitoring contractors.

Qualifications: 

Education:

The minimum level of education and experience required to perform the job.

• High School, GED

Licensing & Certification: 

• Valid Driver’s License – Incumbent is required to have and maintain a valid driver’s license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State.

Minimum Qualifications: 

• One year of experience working in government programs such as Medicare or commercial insurance industry. Experience can include processing applications, filing, or billing Medicaid or commercial insurance claims.

Preferred Qualifications: 

Any additional skills, experiences, or qualifications that would be beneficial, but aren’t strictly necessary.

• Word, Excel, PowerPoint, Access
• Proofreading, editing, attention to detail
• Ability to interpret and apply policies affecting agency program operations.
• Ability to conduct formal presentations, or negotiate and persuade to settle issues
• Ability to gather relevant information
• Ability to provide concise and accurate reports
• Analytical and organizational skills
• Customer service experience
• General knowledge of federal and state laws and regulations regarding health insurance claims

About the Position: 

• Who can apply: Anyone (External)
• Classified/Unclassified Service: Unclassified
• Full-Time/Part-Time: Full-Time
• Regular/Temporary: Regular
• Work Schedule: Monday-Friday, 8am-5pm (Flexible schedules available)
• Eligible to Receive Benefits: Yes
• Veterans’ Preference Eligible: Yes

Employment Benefits:

• Comprehensive medical, mental, dental, vision, and additional coverage
• Sick & Vacation leave
• Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave
• Paid State Holidays (designated by the Governor annually)
• Fitness Centers in select locations
• Employee discounts with the STAR Program
• Retirement and deferred compensation programs

How to Apply:

Specific instructions for applying, which might include submitting a resume, cover letter, list of references, or completing an online application.

• Please include the Job ID number (209572) when emailing.

Job Application Process:  Only applications submitted within our State of Kansas Careers Portal will be considered.

• First Sign in or register as a New User at https://admin.ks.gov/offices/personnel-services/jobs
• Complete or update your contact information on the State of Kansas Careers Portal > My Contact Information page. *This information is included on all your job applications.
• Upload required documents listed for each specific job posting.
• Start your draft job application, upload other required documents, and Submit when it is complete.
  • Manage your draft and submitted applications on the Careers> My Job Applications page.
• Check your email and My Job Notifications for written communications from the Recruiter.
  • Email – sent to the Preferred email on the My Contact Information page
  • Notifications – view the Careers> My Job Notifications page

Contact Information:

[email protected]

Salary Range

$ 21.13 to 23.87