Partnered with the State of Wisconsin's Department of Health Services Bureau of Benefits Policy, Spherion is seeking a Medicaid Systems and Coding Analyst!
This position offers the option to work a hybrid model and we also offer benefits, four weeks of annual PTO, and paid holidays.
The Medicaid Systems and Coding Analyst works in the Benefit Support Section within the Bureau of Benefits Policy in the Division of Medicaid Services, which develops and implements non-pharmaceutical Fee-for-service policy under the Wisconsin Medicaid and BadgerCare Plus programs. The incumbent will work across sections/bureaus within the Division of Medicaid Services, act as a subject matter expert for systems and policy staff, and support assigned sections with policy questions, correct coding, and systems implementation needs/requirements. The Analyst serves as the Section's lead for analyzing, developing, implementing, enhancing, and maintaining benefit policy within FFS Medicaid. You will also be responsible for both the day-to-day management and the long-term benefit development within the information system. Additional responsibilities include working cross-collaboratively to develop and review information system requirements according to benefit policy; reviewing and approving system documentation such as project charters, business requirements, functional requirements, and Detailed System Design (DSD) documents; identifying and responding to system defects and incorrect claims payments as needed; participating in system design meetings; and interpreting the data after benefit policy is developed and implemented in the system.
Key Responsibilities:
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- Analyze, evaluate, direct, and monitor the implementation of policies, reimbursement methodologies, medical coding updates, and changes in state and federal law related to services covered under the Medicaid program for assigned policy areas and provider types to determine the impact of policy on systems
- Analyze policy changes, state and federal regulations, and state administrative codes to prepare system requirements/specifications for necessary system or procedural changes and enhancements to implement these requirements in assigned subsystems and provider areas
- Provide direction and technical assistance to internal staff on system maintenance and management to improve manual and electronic data processing procedures
- Meet with users and policy analysts of these policy areas to determine system problems, prepare an analysis of these problems, develop system specifications and tests to correct those problems, and monitor their implementation
- Become a medical coding subject matter expert for DMS. Support staff on coding needs for various projects
- Conduct special projects to evaluate and monitor the impact of policy changes on the MES after implementation
- Direct the implementation of Medicaid policy in the MES, the maintenance of written procedures documenting policy and system changes, and conduct special projects to monitor and evaluate the application and effectiveness of policy-impacting systems
- Design, implementation, management, monitoring, enhancement, and evaluation of assigned business area systems and operation of the MES, including data and system analysis
- Clarify and interpret program specifications and requirements with programmers, when necessary
- Evaluate the impact of policy and system changes post-implementation
- Review system requirements including reviewing and approving system documentation such as project charters, business requirements, functional requirements, and detailed system design documents
- Respond to system defects and incorrect processing. Lead efforts from the bureau to understand the defects and coordinate the solution
- Function as lead worker on system-related projects assigned by management
- Act as a lead systems analyst on projects which involve multiple subsystems
- Prepare status reports for Division management on assigned special projects
- Analyze data, prepare data visualizations, and provide a narrative analysis
Essential Qualifications:
- Ability to work independently, under general supervision, and exercise good judgment
- Strong oral and written communication skills
- Ability to understand and follow complex written and oral directions and instructions
- Ability to prepare clear, concise, and complete reports and supporting documentation
- Ability to establish and maintain effective working relationships with bureau staff, state and local agencies, and the general public
- Considerable knowledge of research and policy analysis methodologies
- Knowledge of federal Medicaid statutes and regulations, Wisconsin statutes, and the Wisconsin Administrative Code
- Ability to exercise judgment and discretion in developing, applying and interpreting administrative policies and procedures
- Strong analytical skills, including the use of statistical techniques to analyze large volumes of complex data
- Advanced skills in the use of database information systems, management support systems, and other data processing systems
- Extensive knowledge of data processing applications, including spreadsheet and database software
- General knowledge of Wisconsin’s healthcare industry, including its composition and regulation
- General knowledge of the healthcare billing process, including healthcare claims submission, processing, and payment
- General knowledge of nationally-standardized medical code sets, including National Drug Codes (NDCs), Current Procedural Terminology (CPT) codes, Health Care Procedure Coding System (HCPCS) codes, and International Classification of Diseases (ICD) codes
- General knowledge of the Department’s organization, mission, and functions
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA) regulations
Spherion has helped thousands of people just like you find work happiness! Our experienced staff will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temp-to-perm or direct hire opportunities, no one works harder for you than Spherion.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Spherion, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact Callcenter@spherion.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Spherion offers a comprehensive benefits package, including health, and an incentive and recognition program (all benefits are based on eligibility).
For certain assignments, Covid-19 vaccination and/or testing may be required by Spherion's client or applicable federal mandate, subject to approved medical or religious accommodations. Carefully review the job posting for details on vaccine/testing requirements or ask your Spherion representative for more information.