Program Operations (Data) Specialist- Closes 9/22/17

Position Program Operations (Data) Specialist
Employer Northwest Regional Council
Job Description The Northwest Regional Council, as an Area Agency on Aging, funds and provides community-based programs to help people live in their own homes and communities for as long as possible, postponing or eliminating the need for institutional care. In addition, our agency is a Lead for the Health Home Program that includes a network of Care Coordination Organization’s (CCOs) throughout Island, San Juan, Skagit, Snohomish and Whatcom counties. The Health Home Program provides both intensive care coordination and comprehensive case management for eligible individuals, using health screening/assessment tools, health education, and evidence-based practices to help clients establish health action plans and achieve health goals.
The Program Operations Specialist ensures the integrity and accuracy of and maintains databases for referrals, assignment of cases, tracking and notification systems, and ensuring correct and allowable billing and payment. This position is responsible for initiating systems changes as necessary; performing data entry and developing reports; providing information and technical assistance to providers on use of operational systems; managing required program documentation; verifying Health Home client eligibility and supporting referrals to appropriate CCOs. Duties also include supporting CCO contracting activities, tracking care coordinator orientation and training, and processing payment documents. NWRC has two Program Operations Specialist positions. The position for which we are hiring will focus primarily on the following:

Referral/Eligibility Management
1. Uses the Health Home database to assist with referrals of eligible health home clients to the appropriate Care Coordination Organization (CCO.)
2. Initiates and implements system and database changes as necessary
3. Tracks Health Home “opt-outs” and updates databases accordingly.
4. Responds to/tracks Health Home requests/referrals from providers, CCOs, and the community.
5. Verifies eligibility and coordinates enrollment (not engagement) of individuals eligible for Medicaid and Medicare (dual eligible) services with the state Health Care Authority (HCA.)
6. Provides technical assistance to CCOs about ongoing eligibility and contract requirements for eligibility.
7. Coordinates referrals with the Health Care Authority (HCA.)
8. Coordinates and communicates with Managed Care Organizations (MCOs) and HCA on eligibility and case transfers and directs inquiries related to MCO-related cases to MCOs.
9. Provides information and technical support on measuring engagement efficiency.

10. Acts as point person on billing questions and provides technical assistance to CCOs on billing matters, including Tier classifications
11. Reconciles CCO billings against eligibility and program records
12. Coordinates between CCOs and NWRC budget office
13. Reviews, verifies accuracy and compiles invoices from CCOs and prepares invoices for approval.
14. Reviews files in the database for Health Action Plan (HAP) completion and appropriate tier activity related to billing.
15. Provides technical support to CCOs on HAP development and submission and HAP contract requirements. Participates in CCO contract monitoring.

Qualifications Knowledge, Skills and Abilities:
• Demonstrated ability to work with databases, word processing and spreadsheets at an intermediate skill level.
• Ability to perform complex data analysis.
• Ability to analyze situations accurately and adopt effective course of action.
• Ability to provide technical support/explain complex program processes to community partners.
• Ability to work with efficiency and flexibility under frequent pressure of deadlines.
• Demonstrated ability to learn and master new job responsibilities.
• Ability to maintain confidentiality of client, provider, and staff information.
• Ability to establish and maintain effective working relationships with co-workers, other agency personnel, and the general public using courtesy, tact and good judgment.
• Sensitivity to the needs and values that are present in working with diverse groups of people.
• Broad knowledge of the legal, contractual and financial requirements of the Health Home Program or similar Medicaid programs preferred.


TEN-STEP HOURLY RANGE: $20.70 – $27.01, DOQ
Days/Hours 40 hours/wk
Contact Info Human Resources

BUSINESS ADDRESS: 600 Lakeway Dr Suite 100 Bellingham WA 98225


PHONE: 360.676.6749

How to Apply    Application materials may be requested by contacting the Bellingham Office @ 360-676-6749, e-mailing, or downloading directly from All applications and application materials, including a cover letter and resume, must be fully completed and returned to the Bellingham office by Friday, Sept. 22, 2017. NWRC is an Equal Opportunity Employer
Position Closes September 22, 2017