Medicaid Provider Audits & Investigations (MPAI) Supervisor - Human Services Supervisor 3

About the role

The Medicaid Provider Audits & Investigations (MPAI) Supervisor directs the identification and investigation of fraud, waste, abuse and error by health care providers and recipients participating in Minnesota’s Health Care Program (MHCP).

Responsibilities

• Enforce compliance with state and federal laws and regulations governing the programs.
• 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.
• 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 regulations regarding the Medicaid Management Information System (MMIS).
• Develop and maintain relationships with other units of DHS, other state agencies, health related licensing boards, professional associations and federal agencies so that external resources are available for, and coordinated with, MPAI activity and to improve program integrity policies.

Requirements

• Demonstrated leadership experience.
• Knowledge of federal regulations, state statutes, and departmental rules, policies and procedures governing publicly funded health care programs.
• Skilled in problem solving and decision making.
• Experience with the administrative hearing process and testifying at hearings.
• Knowledge of Department of Human Services (DHS) systems such as MMIS, MAXIS, and the Data Warehouse.
• Understanding of local human service agencies, state welfare systems and health care delivery systems.
• Ability to utilize technical skills primarily to analyze data and make logical recommendations.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Qualifications

• Four (4) years of experience conducting claims, healthcare, or human services investigations or audits; monitoring or overseeing publicly funded healthcare programs, including Minnesota Health Care Programs; or administering compliance with and/or enforcement of state and federal laws governing publicly funded healthcare programs, including healthcare fraud investigations.
• Investigative methods, interviewing techniques, and/or investigatory processes sufficient to direct complex provider investigations and evaluate investigative findings.
• Hire employees, assign work, and/or evaluate employee performance to meet program objectives.
• Develop, approve and/or implement policies.

Skills

• Leadership experience.
• Knowledge of federal regulations, state statutes, and departmental rules, policies and procedures governing publicly funded health care programs.
• Problem solving and decision making skills.
• Administrative hearing process and testifying at hearings.
• Technical skills to analyze data and make logical recommendations.
• Effective communication with technical and non-technical personnel.
• Relationship building with other units of DHS, state agencies, health related licensing boards, professional associations and federal agencies.

Benefits

• Paid vacation and sick leave.
• 12 paid holidays each year.
• Low-cost medical, dental, vision, and prescription drug plans.
• Fertility care, including IVF.
• 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.