Bidders – Please note that you will be required to provide an updated resume to the hiring supervisor/manager for this position.

This position exists to screen, enroll and maintain provider records to ensure State and Federal requirements are met to reduce Medicaid fraud, waste and abuse. Minnesota Health Care Programs (MHCP) enrolls more than 70 types of individual and organizational providers to serve our recipients and receive payment for those services. More than 250,000 individual and organizational providers are enrolled and required to sign a provider agreement and abide by and accept state and federal policies and payments. Each provider type is unique and must meet specific criteria to enroll. Provider Eligibility & Compliance (PEC) is responsible for: • Creating and maintaining provider enrollment criteria and procedures; • Determining the eligibility of these providers; • Processing initial enrollment applications; • Working with these providers to maintain MHCP eligibility through ongoing screening, certification, and licensure and evolving program requirements PEC is charged with managing and maintaining the data in the MMIS/MPSE provider subsystem. We partner with the DHS OIG, the Attorney General's (AG) office, and other state and federal agencies to maintain the integrity of our provider data and to prevent fraud, waste and abuse in our health care programs. PEC oversees the central repository of the supporting documentation that is required as proof in order to enroll MHCP providers. The PEC Specialist responsibilities include: • Analysis, interpretation and application of internal, state, federal and national requirements for determining the eligibility and enrollment of counties, health care providers, provider groups and other health care entities providing services to enrollees in the Medicaid program • Monitoring, review and verification of provider information to determine impact on eligibility, type, and level of reimbursement • Research and respond to inquiries regarding provider enrollment and compliance with policy, procedures and decisions. Research, draft and analyze findings of ad hoc studies and reports related to PEC policies and activities • Investigate, review and prepare recommendations for modifications, changes, and edits to systems, operations, policies and procedures

**To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month, day and year for each job held.** 2 years advanced administrative support, paraprofessional, or technical experience OR Associate degree in related field and 1 year advanced administrative support, paraprofessional, or technical experience OR Bachelor’s degree in related field Experience must include the following: • Experience with policies, procedures, and operations associated with Medicaid provider enrollment process and eligibility criteria • Experience reviewing applications and determining eligibility • Experience with MPSE, MMIS or other claims processing subsystems