Medicaid Policy & Regulation Analyst

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add a Medicaid Policy & Regulation Analyst to our SGS team of talented professionals.

 

What you'll do:

 

This Policy & Regulation Analyst primary responsibilities are to research, understand, and articulate Federal and State regulations and policy as they relate to the administration of the State Medicaid programs, including Managed Care Programs, for those states within the northeastern jurisdiction. As the subject matter expert, the position will work to gain an understanding of these programs and their respective state-specific nuances, with particular focus on Managed Care. The individual will collaborate with the broader Medicaid team to conduct research and provide education in support of project development or in response to referrals.

 

Additional Responsibilities:

• Articulate policy/regulations in both a written manner and through discussion/presentation.
• Provide a written policy contribution for incorporation into the Analytical Findings Report.
• Consult to identify projects in collaboration with the Project Coordination team and the Data team.
• Identify potential program vulnerabilities arising out of policy research.
• Interact with states and respective Managed Care Plans (MCPs) within the jurisdiction to engage in policy discussions, gain access to MCP policies and procedures, and understand each MCP’s interpretation of Federal and State requirements.
• Interact with CMS to engage in policy discussion.
• Keep abreast of emerging issues and developments that directly impact State Medicaid programs within the jurisdiction, including changes in Managed Care policy and administration.
• Assist the Medicaid Operations Lead with special research projects as requested.
• Ownership of the Medicaid Policies & Procedures Manual to include an annual review to determine if direction is current, which may include needed updates as well as ad hoc updates as direction changes (i.e., internally or by the customer).
• Track policy workload and report monthly to the Medicaid Operations Lead.
• Collaborate closely with the current Policy & Regulation Analyst to provide mutual support and serve as one another’s backup as needed.
• Position will be Telework available

Basic Qualifications:

• 5 years with BS/BA; 3 years with MS/MA
• Experience in policy and/or regulatory research and analysis.
• Ability to clearly communicate, both in writing and verbally, state and Managed Care policies and regulations and explain their impact on projects.
• Ability to research, interpret, and synthesize policy and regulatory rules/guidance into concise analyses
• Strong interpersonal skills: ability to work and make decisions independently and in a team environment.
• Excellent planning, organizational skills.
• Excellent oral and written communication skills; able to communicate effectively and deliver presentations to all levels of management and associates across the Company, as well as to external stakeholders (i.e., CMS, States, and Managed Care Plans).
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Ability to adapt to changing priorities, self-motivated and energetic qualities desirable.
• Experience using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook).
• US Citizenship required

The most competitive candidates will have:

• Experience with CMS programs – Medicaid and Medicare.
• Experience with Managed Care programs.
• Knowledge of CMS regulations related to State Medicaid programs to include waivers.
• Knowledge of CMS 64 – analyse and interpret reports to determine trends and vulnerabilities.
• Knowledge of Federal Matched Assistance Program to State Medicaid programs.
• Medical Coding knowledge/experience related to billing of Medicare/Medicaid claims a plus.

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

$66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.