Program Integrity Coordinator, Managed Care Organizations (mcos) / Human Services Program Representative 2 - Remote Eligible

Program Integrity Coordinator, Managed Care Organizations (MCOs)

Job Class: Human Services Program Representative 2

Agency: Human Services Dept

Location: St. Paul

Telework Eligible: Yes

Full/Part Time: Full-Time

Regular/Temporary: Limited

Who May Apply: Open to all qualified job seekers

Salary Range: $32.40 - $47.76 / hourly; $67,651 - $99,722 / annually

Classified Status: Unclassified

Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE

FLSA Status: Nonexempt

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.

Approximately, 10% travel.

This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.

Minnesota's contracted Managed Care Organizations (MCOs) are required by federal rule and as a condition of contracting with the State of Minnesota to conduct a variety of program integrity activities and establish Special Investigations Units (SIUs) that conduct specific activities designed to prevent, detect, and respond to fraud, waste, abuse, and noncompliance with certain contractual or other regulatory requirements that results in improper payments. In turn, the State of Minnesota, through its Office of Inspector General, is required to ensure that MCOs implement and maintain effective integrity programs designed to detect and prevent fraud, waste, and abuse in the Medical Assistance (MA) program.

This position is responsible for proposing, designing, developing, and coordinating critical program integrity, compliance and anti-fraud initiatives across the MCOs and between the Fee-For-Service (FFS) program. This includes multiple program activities designed to improve compliance, accountability and return on investment.

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 experience in Medicaid program integrity, health care compliance, audits, investigations, or fraud, waste, and abuse (FWA) activities

AND

Experience must demonstrate the following:

Knowledge of Minnesota Health Care Programs (MHCP) or other Medicaid programs, including managed care and/or fee-for-service delivery systems.

Experience analyzing program integrity, compliance, audit, or investigative data and applying relevant laws, policies, and contractual requirements.

Interpret and apply federal and state laws, regulations, and policies related to Medicaid or other publicly funded health care programs.

Experience coordinating work with multiple internal and external stakeholders.

Proficiency in Microsoft Word and Excel, including the ability to prepare reports, documentation, and summaries.

Preferred Qualifications

Experience working with Managed Care Organizations (MCOs), including oversight of contractual program integrity or Special Investigation Unit (SIU) activities.

Experience with Medicaid fraud referrals, concurrent investigations, or coordination with entities such as MFCU, AGO, CMS, or law enforcement partners.

Advanced knowledge of Medicaid program integrity laws and regulations, including credible allegation of fraud standards and sanction processes.

Experience developing or implementing policies, procedures, quality metrics, or oversight processes.

Experience using data analytics, dashboards, or visualization tools to identify trends, aberrancies, or program integrity risks.

Knowledge of Minnesota Medicaid claims processing, coding systems, or encounter data.

Experience providing training, technical assistance, or formal presentations to internal or external stakeholders.

Project management or continuous improvement experience related to program integrity or compliance initiatives.

Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

This position requires successful completion of the following:

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

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.