Federal Audit Contract Coordinator / Human Services Program Consultant

Federal Audit Contract Coordinator

The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

This position will direct and coordinate federally mandated contractors, such as the Recovery Audit Contractor (RAC), the Unified Program Integrity Contractor (UPIC), and other contractors engaged by the Department to address program integrity issues in Minnesota Health Care Programs (MHCP).

Responsibilities include but are not limited to:

• Direct and manage the scope of the RAC, UPIC, and other contractor audits.
• Act as liaison on contractor matters with providers, provider associations, other Department of Human Services (DHS) divisions and administrations, and federal and state agencies impacted by contractor activities.
• Ensure and enforce contractor compliance with state and federal regulatory and contractual requirements.
• Oversee the reporting obligations of the contractors to assure legal and contract requirements are met and to assure that resulting payments to the contractors are appropriate.
• Independently investigate, lead, and mentor other staff to initiate, develop, and resolve program integrity related cases which could lead to administrative actions.

Minimum Qualifications

To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.

Three (3) years of specialized professional experience with receiving, identifying, and/or conducting a full range of regulatory investigations designed to detect, identify, correct, and/or resolve instances of suspected fraud, waste, and abuse by providers.

AND

Experience must demonstrate the following:

• Auditing health care claims.
• Represent agency program integrity efforts and related policies, rules, and statutes, to contracted vendors, auditors, and agency staff to assure vendor projects.
• Develop processes, procedures, and trainings about contracted vendor work and present to both internal and external stakeholders.
• Health care policy development.
• Develop and maintain a system for assessing the contractor's compliance with contract terms.
• Assess contractors' compliance with state and federal regulations and contractual requirements.

Preferred Qualifications

Knowledge of:

• ICD-10, CPT and HCPCS coding experience and/or certification.
• Federal and state laws and rules governing RACs and UPICs.
• Minnesota Health Care Programs, and specifically Medicaid.
• Fee-for-service and managed care programs.
• Medicare program and how it interacts with the Medicaid program.
• Third party liability and benefit recovery principles.
• Minnesota Medicaid Information System (MMIS) and the Data Warehouse.
• Minnesota Medicaid claims processing and coding systems.
• Experience conducting data mining and data analytics.
• Working knowledge of principles and practices of provider audits, program integrity initiatives, healthcare delivery systems, and health care provider roles.
• Extensive knowledge and experience using Excel.
• Comfort with Microsoft Word and SharePoint.
• Effectively manage work load and deadlines.
• Skilled in problem solving and decision-making techniques.
• Speaking clearly and confidently, in both large and small group settings.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

This position requires successful completion of the following:

• Criminal background check.
• Reference check.
• Fingerprinting check (MNJIS/CJIS).
• Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.

AN EQUAL OPPORTUNITY EMPLOYER

Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.

Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email careers@state.mn.us. Please indicate what assistance is needed.