Program Integrity Coordinator, Managed Care Organizations (MCOs) / Human Services Program Representative 2

About the role

This Temporary Unclassified position is responsible for proposing, designing, developing, and coordinating critical program integrity, compliance and anti-fraud initiatives across the Managed Care Organizations (MCOs) and between the Fee-For-Service (FFS) program. This includes multiple program activities designed to improve compliance, accountability and return on investment.

Responsibilities

• Propose, design, develop, and coordinate program integrity, compliance, and anti-fraud initiatives across MCOs and FFS program.
• Analyze program integrity, compliance, audit, or investigative data and apply relevant laws, policies, and contractual requirements.
• Interpret and apply federal and state laws, regulations, and policies related to Medicaid or other publicly funded health care programs.
• Coordinate work with multiple internal and external stakeholders.
• Prepare reports, documentation, and summaries using Microsoft Word and Excel.

Requirements

• Three (3) years of experience in Medicaid program integrity, health care compliance, audits, investigations, or fraud, waste, and abuse (FWA) activities.
• Knowledge of Minnesota Health Care Programs (MHCP) or other Medicaid programs, including managed care and/or fee-for-service delivery systems.
• Experience analyzing program integrity, compliance, audit, or investigative data and applying relevant laws, policies, and contractual requirements.
• Experience coordinating work with multiple internal and external stakeholders.
• Experience in Microsoft Word and Excel, including the ability to prepare reports, documentation, and/or summaries.

Qualifications

• Advanced knowledge of Medicaid program integrity laws and regulations, including credible allegation of fraud standards and sanction processes.
• Experience developing or implementing policies, procedures, quality metrics, or oversight processes.
• Experience using data analytics, dashboards, or visualization tools to identify trends, aberrancies, or program integrity risks.
• Knowledge of Minnesota Medicaid claims processing, coding systems, or encounter data.
• Experience providing training, technical assistance, or formal presentations to internal or external stakeholders.
• Project management or continuous improvement experience related to program integrity or compliance initiatives.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Skills

• Strong analytical skills.
• Excellent communication and interpersonal skills.
• Ability to manage multiple tasks and projects simultaneously.
• Proficiency in Microsoft Word and Excel.

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.

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.
• 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.