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Working Title: Medicaid Provider Audits and Investigations Supervisor

Job Class: Human Services Supervisor 3

Agency: Human Services Dept

• Job ID : 77835

• Location : St. Paul

• Telework Eligible : Yes

• Full/Part Time : Full-Time

• Regular/Temporary : Unlimited

• Who May Apply : Open to all qualified job seekers

• Date Posted : 06/22/2024

• Closing Date : 07/05/2024

• Hiring Agency/Seniority Unit : Human Services Dept / DHS Central Office MMA

• Division/Unit : Department of Human Services (DHS) / Office of Inspector General (OIG) SIRS MA Prov Inv

• Work Shift/Work Hours : Day Shift / 8:00 a.m. - 4:30 p.m.

• Days of Work : Monday - Friday

• Travel Required : No

• Salary Range: $35.98 - $51.83 / hourly; $75,126 - $108,221 / annually

• Classified Status : Classified

• Bargaining Unit/Union : 216 - Middle Management Association/MMA

• FLSA Status : Exempt - Executive

• Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes

The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment.

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.

Medicaid Provider Audits and Investigations Supervisor

*This position is currently eligible for full-time telework, but possible onsite work will be required. Telework allows an employee to perform work from a telework location and an employee may be required to be in the office based on business needs and other dependencies in St. Paul, Minnesota. Only candidates located in Minnesota and bordering states (Iowa, North Dakota, South Dakota, or Wisconsin) are telework eligible.

To direct the identification and investigation of fraud, waste, and abuse by health care providers participating in Minnesota’s Health Care Program (MHCP); and to enforce compliance with state and federal laws and regulations governing the programs. The supervisor must direct Medicaid Provider Audits & Investigations (MPAI) investigators in the performance of their duties.

Responsibilities include:

· Exercise supervisory authority to ensure that applicable labor agreements and plans are equitably administered and employees will effectively perform assigned job duties to achieve the objectives of the section.

· Oversee case assignments and progress to ensure appropriate and consistent action is taken

· Administer the Medicaid Provider Audits & Investigations (MPAI) Unit so that there is compliance with, and enforcement of, state and federal laws regarding Minnesota’s publicly funded health care programs.

· Direct the development, implementation, and maintenance of an effective system for analysis of provider data so that possible provider and recipient misuse of services or billing may be identified and there is substantial compliance with federal and state regulations.

· Supervise the development and maintenance of a recording and reporting system regarding activities of MPAI so that there is compliance with state and federal regulations and so that data is available for planning and administrative purposes.

· Monitor, evaluate and maintain Department of Human Services rules governing the identification and investigation of fraud and abuse in Minnesota’s publicly funded health care programs.

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.

Demonstrated leadership experience*

*Leadership experience can include:

· Experience as a supervisor, lead worker, team lead, project lead or mentor;

· Completion of a State of Minnesota leadership program (e.g. ELI, L4);

· A paid/unpaid position leading a program or chairing a committee (e.g. ERG) - experience must include:

o 1+ year of experience identifying issues, goals and strategic actions

o 100+ hours per year time commitment

AND

Four (4) years of specialized professional work in conducting health care or human service investigations or audits and quality monitoring/oversight of funded programs.

Experience must demonstrate the following:

• Knowledge of federal Medicaid regulations, state statutes, policies and procedures.

· Knowledge of local human service agencies, state welfare systems and health care delivery systems.

· Investigations, interviewing techniques, and investigatory process.

· Technical skills primarily to analyze data and make recommendations.

Preferred Qualifications

· Knowledge of federal regulations, state statutes, and departmental rules, policies and procedures related to the public programs administered by the department.

· Experience with the administrative hearing process and testifying at hearings.

· Knowledge of DHS systems such as MMIS, MAXIS, and the Data Warehouse.

· Understanding interrelationships of data, information, and evidence that are obtained or observed during an investigation.

· Ability to review work of subordinates to ensure it meets legal requirements, performance expectations, timeliness goals, and is accurate.

· Analyze and interpret investigative techniques for both their intended and unintended effect.

· Able to effectively communicate with both technical and non-technical personnel, to county users, internal DHS staff or external agencies.

· Ability to build working relationships to solve problems and achieve unit or agency goals.

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

Additional Requirements

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.

REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.

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.