Federal Audit Contract Liaison / Human Services Program Rep 2

Federal Audit Contract Liaison

This position will assist in the direction and coordination of 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:

• Assist in the management of the scope of the RAC, UPIC, and other contractor audits.
• Serve 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.
• Assist in ensuring and enforcing contractor compliance with state and federal regulatory and contractual requirements.
• Assist in ensuring the reporting obligations of the contractors according to contract requirements are met and that resulting payments to the contractor are appropriate.
• Investigate 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 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:

• Ability to represent agency program integrity efforts and related policies, rules, and statutes, to contracted vendors, auditors, and agency staff to assure vendor projects.
• Recommend the auditing of program areas.
• Prepare accurate materials regarding contractor work.
• Format, analyze, and prepare computer generated reports and conduct claims analyses.

Preferred Qualifications:

Knowledge of the following:

• ICD-10, CPT and HCPCS coding experience and/or certification.
• Federal and state laws and rules governing RACs and UPICs
• Minnesota HealthCare 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
• Analytic tools and data mining to identify Medicaid misbilling, overpayments, and fraud
• Principles and practices of provider audits, program integrity initiatives, health care delivery systems, health care provider roles and responsibilities.

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.