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Minnesota Department of Human Services · 14 hours ago

Quality Assurance and Improvement Analyst / Human Services Program Representative 2

St Paul, MN

Full-time

Hybrid

Mid Level

$32.40/hr - $47.76/hr

3+ years exp

The Minnesota Department of Human Services is dedicated to improving the well-being of Minnesotans through essential services and policies. They are seeking a Quality Assurance and Improvement Analyst to protect the integrity of Minnesota Health Care Programs by identifying errors and trends, providing recommendations for improvements, and ensuring compliance with state and federal regulations.

Government Administration

No H1B

Responsibilities

Reviews and evaluates MHCP approved and denied enrollment requests to determine if the program is achieving its objectives by outlining report criteria and reviewing results in order to propose solutions, resolve problems discovered during the evaluation, and monitor outcomes. Documents problems and solutions, while continually analyzing and organizing data to ensure the integrity of program activity in relation to enrollment of qualified providers

Represent the Member and Provider Services (MPS) Division at meetings with internal and external stakeholders to ensure that adequate information is effectively communicated within program guidelines

Provide technical assistance to DHS staff and work with others on joint projects related to provider screening and enrollment activities and proper payment of claims

Advise stakeholders (MHCP program and service policy staff, MN.IT, state and federal auditors, DHS OIG, Attorney General's Office, DHS FOD, provider associations and other provider stakeholder groups) with a comprehensive understanding of all procedural and technical aspects of program activities in relation to enrollment activities and system coding so that requested supports are within the limitations of the regulations and policies involved; assessing whether or not program parameters have been met; analyzing resource distribution to avoid duplication within or between programs; verifying that provided services are consistent with program plans. Provide on-site technical assistance, training and presentations on the Provider Enrollment processes

Determines compliance with MHCP programs so that management is kept up to date on program activities, and program needs are identified by monitoring and identification of issues and problems, such as systems logic applicable to meet State and Federal regulations

Conduct detailed and comprehensive research of the Minnesota Provider Screening Enrollment Portal (MPSE) and MMIS system change requests to proactively identify changes that will affect the integrity of the enrollment process so that program activities, program needs, and future program services are identified and addressed

Provide enrollment expertise to external and internal stakeholders regarding the integrity of decisions to approve, deny, terminate, or take other action on a provider record by testifying in court cases and/or working with auditors

Implement enrollment status changes that affect financial reporting systems for state, federal, and other funding sources. Determine when it is necessary to notify other appropriate business areas, such as policy areas or claims processing, of action taken on a provider record and ensure the necessary communication is documented

Develop recommendations for enhancements or changes in legislation that enable Provider Enrollment to continue adding efficiencies to the processes for both DHS and providers

Qualification

Minnesota Health Care ProgramsCompliance requirementsQualityCompliance reviewData analysisContinuous improvement principlesLeadership skillsProblem-solvingCommunication skillsCollaboration

Required

3 years professional experience with Minnesota Health Care Programs (MHCP) operations or similar healthcare/ insurance related experience

Experience with compliance requirements for healthcare programs

Experience with conducting quality and compliance review activities to ensure alignment with state and federal requirements, identifying errors, gaps and trends

Experience analyzing business and workflow impacts of policy and system changes

Bachelor's Degree in Public Health, Health Care Administration, Public Administration or related field may substitute for 1 year of experience OR Master's degree in Public Health, Health Care Administration, Public Administration or related field may substitute for 2 years of experience

Preferred

Leadership skills with ability to develop the skills and capabilities of staff

Able to approach problems with functional analysis perspective

Ability to identify gaps or trends and solutions to improve processes, procedures and regulations

Knowledge of continuous improvement principles

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

Benefits

Paid vacation and sick leave

12 paid holidays each year

Low-cost medical, dental, vision, and prescription drug plans

Fertility care, including IVF

Diabetes care

Dental and orthodontic care for adults and children

6 weeks paid leave for parents of newborn or newly adopted children

Pension plan that provides income when you retire (after working at least three years)

Employer paid life insurance to provide support for your family in the event of death

Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury

Tax-free expense accounts for health, dental, and dependent care

Resources that provide support and promote physical, emotional, social, and financial well-being

Training, classes, and professional development

Tuition reimbursement

Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)

Employee Assistance Program (EAP) for work/life support

A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance

Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues

Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care