Minnesota Department of Human Services · 5 hours ago
Federal Audit Contract Liaison / Human Services Program Representative 2
St Paul, MN
Contract
Hybrid
Mid Level
$68K/yr - $100K/yr
3+ years expThe Minnesota Department of Human Services is dedicated to improving the well-being of Minnesotans through essential services and policy development. The Federal Audit Contract Liaison will oversee federally mandated contractors to ensure compliance and address program integrity issues within Minnesota Health Care Programs.
Government Administration
No H1B
Responsibilities
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
Qualification
Required
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
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 particular program areas
Prepare accurate materials regarding contractor work
Format, analyze, and prepare computer generated reports and conduct claims analyses
Preferred
Knowledge of ICD-10, CPT and HCPCS coding experience and/or certification
Knowledge of federal and state laws and rules governing RACs and UPICs
Knowledge of Minnesota HealthCare Programs, and specifically Medicaid
Knowledge of fee-for-service and managed care programs
Knowledge of Medicare program and how it interacts with the Medicaid program
Knowledge of third party liability and benefit recovery principles
Knowledge of Minnesota Medicaid Information System (MMIS) and the Data Warehouse
Knowledge of Minnesota Medicaid claims processing and coding systems
Knowledge of analytic tools and data mining to identify Medicaid misbilling, overpayments, and fraud
Knowledge of principles and practices of provider audits, program integrity initiatives, health care delivery systems, health care provider roles and responsibilities
Maintain contact with state licensing boards, law enforcement, county human services agencies, and other state agencies when contractor audits reveal issues relating to professional conduct or patient care
Provide technical assistance and guidance on DHS policy to the contract administrators, auditors, and claims staff to assure successful audit projects
Resolve routine disputes between MHCP providers and contractors' staff. Escalate sensitive and/or complex disputes as needed
Skilled in problem solving and decision-making techniques
Knowledge and proficiency using Microsoft Word, Excel, and SharePoint
Effective customer service practices
Variety of experiences working effectively with others from different backgrounds and 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
Company
Minnesota Department of Human Services
The Minnesota Department of Human Services (DHS) helps provide essential services to Minnesota’s most vulnerable residents.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Marshall E. Smith, MHA, FACHE
Health System Chief Executive Officer
Breanna B.
Human Resources Business Partner
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