Preliminary Investigator / Human Services Program Representative 1

*This position is eligible for telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) 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.

The Preliminary Investigator will apply knowledge and investigative expertise in order to identify, investigate, and take administrative or legal action in response to suspected fraud, over-utilization and/or abuse of the Minnesota Health Care Programs (MHCP) by enrolled providers.

Duties will include but are not limited to the following

• Investigation of activities related to fraud, abuse or over utilization by Minnesota Health Care Program providers.
• Review and properly conclude all cases identified through profiling, investigation, assigned by the Manager or Supervisor, through referrals from providers, recipients, other DHS state, local and federal agencies, other third-party payers and the general public.
• develop criteria and parameters which will be used to identify provider activity that can be compared to other providers to develop potential cases for investigation.

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.

Two (2) years professional experience with investigative techniques and problem resolution skills to manage the investigation and resolution of cases within limitations set by regulations, law and policy; AND, * Working knowledge and capabilities of automated computer systems and databases and be able to access, extract, manipulate and present data in different formats to support investigative activities.

• Format, analyze, and prepare computer generated reports.
• Understanding, interpretation and application of Minnesota statutes and rules
• Working knowledge care claims processing operations, claims forms, or editing and coding structures.
• Working knowledge of the Medicaid program and the services that are provided
• Working knowledge of medical terminology and coding
• Presenting factual, investigative reports, referrals, and/or other materials for legal review and consideration in civil or criminal cases.

Preferred Qualifications

• This position requires a high level of organizational skills, and problem-solving skills which will require knowledge of various MHCP programs, statutes, and rules.
• Respond and adapt to changes in priorities, operations practices, policies, procedures, laws, rules and coding systems.
• Possess a global understanding of regulations, law and policy relating to health care services and work in-depth with provisions that directly relate to each given case.
• An understanding of claims, the processing operations, claims forms, edits and coding structures sufficient to be able to understand the procedures followed and decisions made by claims processing staff.
• Apply strong customer service skills while performing the regulatory functions of the job.
• Knowledge of the basic principles of civil and criminal law.
• Critical thinking skills
• Investigative skills
• A background in investigations, legal work such as a paralegal, or medical billing and/or coding.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

Incumbent must possess and maintain a valid driver’s license.

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