Medicaid Policy & Regulation Analyst Position

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.

What you'll do:

This position is on the SGS NE UPIC contract supporting Medicaid initiatives across the northeastern jurisdiction. The northeastern jurisdiction includes the following states:

Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, and the District of Columbia.

This individual’s 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 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 nuances by state and work with the greater Medicaid team to primarily research and educate in tandem with 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 the states in the jurisdiction to engage in policy discussion.
• Interact with CMS to engage in policy discussion.
• Keep abreast of emerging issues and developments that have direct impact on the state Medicaid programs within the jurisdiction.
• 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.
• Oversee state meeting agendas and minutes process in coordination with the Business Analyst.
• Position will be Telework available from all states and time zone(s).

Basic Qualifications

• 5 years with BS/BA or 9 years with a HS Diploma
• At least 5 years’ experience in policy research and analysis.
• Ability to present and discuss state policies and regulations in connection with project impact.
• Ability to research policies, interpret regulations and regulatory rules/guidance.
• Strong interpersonal skills: ability to work and make decisions independently and in a team environment.
• Excellent planning, organizational skills.
• Excellent oral and written communications; able to communicate and make presentation to all levels of management and associates at all levels throughout the Company.
• 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.