Medicaid Payments Program Integrity and Systems Coordinator / Human Services Program Consultant

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 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. 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.

This position exists to provide advanced professional knowledge as a business owner and coordinator to provide guidance, prioritize, plan, lead, and support Medicaid’s efforts for its payment system maintenance, operations, development and implementation for multiple business areas within the Medicaid program so that it meets the needs of a wide variety of stakeholders. The person in this role serves as a Medicaid payments policy content expert and speaks on behalf of his/her administration in interactions with business architects, developers and other IT project leads to ensure that IT staff clearly understand their business, including its policies, programs and clientele and have timely information necessary to successfully maintain, operate, develop and modernize the claims payment IT system. He/she ensures compliance with federal and state policies, laws and regulations necessary to implement Medicaid program requirements.

This position will

• Provide strategic and tactical guidance, support, and oversight of Medicaid payment activities and projects by developing, updating and implementing activities as they relate to system, policy, procedural or operational changes that occur as a result.
• Develop, direct and coordinate implementation of MHCP program integrity and compliance policies and, directives to ensure systems and operational procedures are compliant with all relevant federal and state statutes and regulations.
• Partner with DHS HCA, OIG and MFCU to set strategies for, develop, implement and oversee MPPS business unit efforts and claims payment system to apply pre-payment review activity in an effort to prevent of fraud, waste and abuse within the MHCP programs. Act as a subject matter expert on various complex issues and interactions among health care and other related programs

MPPS operationalizes systems and policies necessary to process payment transactions for services provided through a wide array of programs and for external systems that utilize the data or information stored within the systems operated by the business units.

3 years of professional experience with health care programs such as Minnesota Health Care Programs. Experience must demonstrate the following:

• Thorough understanding or ability to develop expertise in Minnesota Health Care Programs in a short time-frame
• Knowledge and experience with Medicaid policy, systems, benefits, and service delivery sufficient to understand how multiple computer systems operate, interact, and interface so that solutions are identified and system design problems are resolved
• Ability to organize and manage a broad spectrum of constituencies while addressing complex health care payment policies and goals
• Knowledge of and ability to adhere to DHS’ policies, procedures, and protocol for handling its state legislative responsibilities and submitting documents for legislative application
• Ability to apply technical expertise in and extensive knowledge base relating to Medicaid and associated state and federal laws, policies, and regulations
• Ability to monitor, analyze, and advise on trends and developments related to payment policy
• Strong oral and written communications skills, * Strategic planning and organization skills
• Problem solving ability that uses a logical, sequential approach
• Decision making
• Planning, organization, and time management skills
• Variety of experiences working effectively with others from different backgrounds and/or 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.