Job Description
PLEASE ATTACH THE ADDITIONAL REQUIREMENTS LISTED AT THE BOTTOM OF THIS PAGE Job ID: 31144
Agency: Department of Social Services Division of Medical Services
Location:Pierre, SD; Other locations may be considered for current employees of DSS in the Division of Medical Services
Salary: $57,399.12 to $71,743.68, depending on qualifications
Pay Grade: J
Closing Date: 05/09/2025
This is a Full-Time 40 Hour Weekly position with the Department of Social Services. For more information on the Department of Social Services, please visit https://dss.sd.gov/ .
The South Dakota Department of Social Services, Division of Medical Services also knowns as South Dakota Medicaid plays a vital role in the healthcare of many South Dakotans. The program is one of the largest healthcare insurers in South Dakota, covering 150,000 individuals in state fiscal year 2025. The program primarily covers children of low - income families including approximately 50 percent of children in South Dakota under age one. Other individuals covered by South Dakota Medicaid include low-income pregnant women, parents, and other caretaker relatives, seniors in nursing homes, and individuals with physical or developmental disabilities.
The State of South Dakota Department of Social Services, Division of Medical Services, is looking for a highly motivated and skilled individual for the role of Program Specialist to perform in depth analysis of current Medicaid policy and outcomes to inform recommodifications for potential program improvements. The position will also develop and update provider manuals, draft provider and recipient communication documents, prepare reports, and work on other special projects.
Specific duties include the following:
- develop and evaluate Medicaid policies and procedures including drafting policy recommendations, provider manual updates, and internal processes;
- conduct analysis of Medicaid claims data using Excel including utilizing advanced Excel functions;
- develop fiscal impact estimates related to potential policy changes;
- coordinate implementation of policy changes with the claims processing unit including educating the team and monitoring implementation;
- manage the Medicaid procedure and diagnosis coding update processes;
- manage the Medicaid provider reimbursement and coverage change request process;
- manage the school district policy and annual rate setting process including serving as the liaison for school districts;
- manage the Birth to Three policy including serving as a member of the Birth to Three Interagency Collaborative Council;
- manage and lead special projects or workstreams for the department to enhance and modernize the program;
- lead the Medicaid provider manual comprehensive review and update process; and
- draft provider and recipient communications.
The Ideal Candidate Will Have: - strong logical reasoning and critical thinking skills;
- strong attention to detail;
- strong leadership skills;
- effective verbal and written communication;
- a bachelor's degree in business, healthcare administration, or another relevant field or or strong relevant work experience is preferred.
Knowledge, Skills, and Abilities: Knowledge of:
- Medicaid and public assistance programs;
- State and federal statutes and administrative rules related to Medicaid; and
Skill to:
- reason logically and think critically to make decisions; and
- prepare clear and concise documents, reports, and correspondence that reflect relevant facts.
Additional Requirements: To be considered, please attach your resume. This position is exempt from the Civil Service Act.
This position is eligible for Veterans' Preference per ARSD 55:10:02:08.
All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.
The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at https://bhr.sd.gov/job-seekers/work-for-state-government/ . This position is a member of Class A retirement under SDRS.
Must apply online: https://gen-stateofsouthdako-trn.inforcloudsuite.com/hcm/xmlhttp/shorturl.do?key=1JO
You must apply online, emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email: careers@state.sd.us
http://bhr.sd.gov/workforus
"An Equal Opportunity Employer"
#LI-Onsite