Federal Audit Contract Liaison / Human Services Program Representative 2
About the role
The Department of Human Services (DHS) is seeking a Federal Audit Contract Liaison to assist in the direction and coordination of federally mandated contractors, such as the Recovery Audit Contractor (RAC), the Unified Program Integrity Contractor (UPIC), and other contractors engaged by the Department to address program integrity issues in Minnesota Health Care Programs (MHCP). This position is eligible for telework for applicants who reside in Minnesota or in a bordering state within 50 miles or less from the primary work location, with supervisory approval and satisfactory performance. Approximately 5% travel is required.
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
Minimum Qualifications
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.
Experience must demonstrate the following:
- Represent agency program integrity efforts and related policies, rules, and statutes, to contracted vendors, auditors, and/or 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 Qualifications
- ICD-10, CPT and HCPCS coding experience and/or certification
- Federal and state laws and rules governing RACs and UPICs
- Minnesota Health Care Programs, and specifically Medicaid
- Fee-for-service and managed care programs
- Medicare program and how it interacts with the Medicaid program
- Third party liability and benefit recovery principles
- Minnesota Medicaid Information System (MMIS) and the Data Warehouse
- Minnesota Medicaid claims processing and coding systems
- Analytic tools and data mining to identify Medicaid misbilling, overpayments, and fraud
- 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
Additional Requirements
This position requires successful completion of a background investigation prior to employment, including criminal background check, reference check, and fingerprinting check (MNJIS/CJIS). The selected individual must also complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment and successfully obtain/retain CJIS certification annually.
Pay
$32.97 - $48.60 / hourly; $68,841 - $101,476 / annually
Schedule
Day Shift / 8:00 a.m. - 4:30 p.m., Monday - Friday
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)
- Employee Assistance Program (EAP) for work/life support including mental health, relationship challenges, grief and loss, finances, and legal issues
- Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care