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DIG PROGRAM ADMINISTRATOR

The Office of Medicaid Inspector General (OMIG) Program Administrator is responsible for overseeing, monitoring, and analyzing data of Medicaid service programs. This position is

Class Code:

G249C

Job Grade:

GS12

Special Job Requirements:

None

Typical Functions:

Supervises staff by interviewing and hiring, providing training opportunities, scheduling work assignments and evaluating the performance of incumbents, and reviewing and approving administrative actions. Researches, prepares, and submits data provided through desk and onsite provider reviews to legislative body, medical providers, and law enforcement entities to determine fraud, waste, and abuse of Medicaid programs. Maintains electronic file of terminated, sanctioned, and excluded medical provides from the Arkansas State Medical Board and Centers for Medicare and Medicaid (CMS) authorities. Responds to various inquiries regarding Medicaid programs, denied claims, provider billing, and procedure code reimbursement guidelines and regulations. Provides technical assistance for provider suspension, debarment, exclusion and enrollment processes, reviews and analyzes special projects, and oversees new program implementation recommendations. Works with agency director on submission of state plan amendment and establishing and implementing short and long range program goals and objectives. Attends meetings and trainings; serves on various committees and task forces to stay abreast of changes impacting Medicaid and other health service programs. Performs other duties as assigned.

Knowledge, Abilities, and Skills:

Knowledge of state and federal personnel policies, practices, and procedures. Knowledge of state and federal Medicaid fraud procedures. Knowledge of supervisory practices and techniques. Knowledge of medical reimbursement codes and terminology. Knowledge of state plan amendment policy and updates. Ability to collect, review, and formulate data into oral and written reports. Ability to monitor and evaluate programs and services. Ability to respond to complaints and inquiries from the public and stakeholders. Ability to implement program recommendations and establish program guidelines. Ability to plan, organize and direct the work of subordinates.

Minimum Qualifications:

The formal education equivalent of a bachelor’s degree in health care administration, social work, public administration, general business, or a related field; plus six years of experience in health care administration or social service programs, or a related area, including four years in a supervisory capacity. Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management. OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.

Required Certificates:

None

Exempt:

E
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