Departmental Specialist 13 - Rates And Encounter Data Section

The MDHHS 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 our MDHHS Diversity, Equity, and Inclusion Plan.

This position of Encounter Standards Specialist serves as Staff Specialist and is the Department's exclusive subject matter expert in processing and utilization of encounter data submitted by managed care entities (i.e. - Medicaid Health Plans, MIChild Health Plans, County Health Plans, Community Mental Health and Substance Abuse Coordinating Agencies) on behalf of the approximately 1 million Medicaid beneficiaries enrolled in the Medicaid Managed Care Program and approximately 100,000 non-Medicaid enrolled clients being served by the Mental Health and Substance Abuse Programs.  This position is responsible for the transition to and subsequent management of encounter data through the Community Health Automated Medicaid Processing System (CHAMPS).  Position duties include the development of procedures and guidelines that allow processing of encounter data through the system and that are consistent with federal reporting requirements.

 This position is responsible for interpretation and implementation of federal mandates resulting from the Administration Simplification portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as relates to encounter reporting for managed care entities contracting with the Michigan Department of Community Health (MDHHS).  Serves as a technical advisor and liaison in working with state contractors, state staff and managed care entities relating to CHAMPS processing requirements and pertinent federal and state requirements.  Recommends, defines and evaluates departmental strategies to allow for operationalization of highly complex federal mandates as applies to reporting requirements.  In addition to serving as  an expert within MDHHS in the development and management of CHAMPS operating procedures as pertains to processing of encounter data, this position serves as the Department's expert  in the utilization of encounter data submitted by the Medicaid managed care entities.

 This includes interpretation and application of federal standards addressing implementation of the National Provider Identifier as it relates to submission and use of the collected data.  Serves as the Technical Expert in independently interacting with and addressing questions from other states regarding issues surrounding the collection, processing and utilization of encounter data.  Responsible for highly complex oversight activities of processing strategies for reporting by Michigan Medicaid managed care entities and incorporation of same in the continuous quality improvement efforts of the Department

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 Education

Possession of a bachelor's degree in any major.

Experience

Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level.

The physical location of this position is 400 S. Pine St., Lansing, MI 48933.  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.

The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises.

As a Condition of Employment: this position requires successful completion of a background investigation and a criminal records check.

The Department of Health & Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received.

For information about this specific position, please email MDHHSVacancies@michigan.gov. Please reference the job posting number in subject line.

If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required. 

Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration.  Only those applicants interviewed will be notified of the results.

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