Job Summary
This position is located within the Department of Health Care Finance (DHCF), Division of Program Integrity (DPI). The mission of DHCF is to improve health outcomes by providing access to comprehensive, cost-effective and quality healthcare services for residents of the District of Columbia. The incumbent serves as an advisor to the Program Manager and is responsible for a wide variety of complex policy and operational issues related to DPI’s mission to provide effective oversight of the District’s Medicaid program. The work requires extensive research and analysis, particularly data analytics, to identify and target vulnerabilities within the Medicaid program and provide advice and guidance on potential solutions.
Duties and Responsibilities
Develops and manages special projects and programs as well as provides special focus and special assistance related to oversight of publicly funded health care programs, including Medicaid, State Children's Health Insurance Program (S-CHIP) and Alliance, health system reform and the emerging D.C. Health Care Exchange. Specifically, the position will focus on identifying vulnerabilities within these programs and advising on innovative solutions. Establishes and maintains relationships with partners and key stakeholders throughout the development of special projects related to identifying fraud, waste, and abuse data trends within the Medicaid provider network; collaborating on joint projects to combat fraud, waste, and abuse; and coordinating regular workgroup sessions to ensure smooth operational efficiency. Performs independent research and analysis of the medical, demographic, legal, ethical, political and financial components of issues and makes recommendations based on research findings.
Mastery knowledge of Medicaid and CHIP requirements from the Centers for Medicare and Medicaid Services (CMS), District laws and rules, Mayor's Orders and court decisions, and understanding of the mission, objectives, strategies, and program goals of DHCF and DPI. Extensive familiarity with the data tools utilized by DHCF, including SAS, PowerBi, Accurint, CaseIQ, and Microsoft Office. Mastery knowledge and understanding of major national healthcare reform efforts including the Affordable Care Act and major factors affecting access to health care by low-income, uninsured and under- insured people. Mastery level knowledge of health care fraud investigatory practices and how to utilize data analytics to identify trends and vulnerabilities within publicly funded health care systems. Ability to use personal computers which include software such as Microsoft Word, Microsoft Excel, Microsoft Access, and Microsoft Outlook. Mastery knowledge of health care terminology and methods.
Qualifications and Education
Specialized Experience: Specialized experience is an experience which is directly related to the position and has equipped the individual with the knowledge, skills, and abilities to successfully perform the duties of the position. To be creditable, the incumbent must possess at least one (1) year of specialized experience equivalent to the next lower grade level in the normal line of progression.
Licenses and Certifications
None
Working Conditions/Environment
The work is performed in a typical office setting.
Other Significant Facts
Tour of Duty: Monday-Friday; 8:15AM - 4:45PM
Pay Plan, Series and Grade: CS-0301-14
Promotion Potential: No Known Promotion Potential
Collective Bargaining Unit (Union): This position is represented by a collective bargaining unit and is subject to union dues thru payroll deduction.
Residency Requirement:
Applicants claiming “Residency Preference” will be required to maintain residency in the District of Columbia for a minimum of seven (7) years. Failure to do so may result in forfeiture of employment.
Position Designation:
The position has been deemed security sensitive. Accordingly, the incumbent will be subject to pre-employment checks (criminal background checks, consumer credit check, traffic record checks, if applicable) as a condition of employment, and will be subject to periodic criminal background checks for the duration of your tenure.
If the position you are applying for is in the Career, Management Supervisory, or Educational Service at an annual salary of one hundred fifty thousand dollars ($150,000) or more, you must establish residency in the District of Columbia within one hundred eighty (180) days of the effective date of the appointment and continue to maintain residency within the District of Columbia throughout the duration of the appointment.
EEO Statement:
The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.
Read Full Description