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

***This position is eligible for telework 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 Lead Program Eligibility Auditor supports the Program Compliance and Audits Manager and Supervisor, acting as their liaison when they cannot be present. The incumbent will report information to management that is relevant to maintaining an efficient and productive work environment. This role also exists to provide a first line resource person for the program eligibility auditors on their team, functioning as a decision maker when two auditors do not agree on an audit finding, an educator when an auditor is unclear on an audit process, relevant policy/regulation or audit procedure, an issue/question escalator when necessary and a subject matter expert (SME) on the audit their team is conducting. Responsibilities include but may not be limited to: • Conduct eligibility reviews (first or second QA). • Conduct medical record & claim error reviews that are a component of the Payment Error Rate Measure (PERM) Review. • Develop, implement, generate and revise as necessary dashboard performance reports for Program Compliance and Audits. • Develop, implement, generate and revise as necessary orientation program documents for Program Compliance and Audits. • Annually update/revise Eligibility review team’s reviewer manual, incorporating federal and state regulatory changes, audit form use updates, reviewer tool use updates, etc.

**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.** Three (3) years of experience in program eligibility and/or auditing. Experience must also demonstrate: • Monitoring and administrating program requirements for eligibility. • Investigating, auditing, reviewing, and analyzing diversified procedures and standards. • Experience working with MAXIS, METS, MMIS and PRISM or other related data management tools and procedures such as input, collection and retrieval systems. • Experience with Microsoft Office applications. *A Bachelor’s degree in Public Health, Health and Human Services, public policy, or another related degree field may substitute for one (1) year of professional experience. OR **A Master’s degree in Public Health, Health and Human Services, public policy, or another related degree field may substitute for two (2) years of experience.

• Experience in Healthcare program eligibility or auditing. • Experience as a lead worker in program eligibility, auditing, or a related field. • Working knowledge of Minnesota’s Health Care and other eligibility programs, regulations, policies and determinations. • Variety of experiences working effectively with others from different backgrounds and cultures.