Interest Bidders: Please have an updated resume ready to submit to the hiring supervisor/manager when requested.

*It is the policy of the Department of Human Services that the individual awarded this position successfully complete a Fingerprinting check (MNJIS/CJIS). *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. *Approximately, 5% travel. This position will 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). Responsibilities include but are not limited to: • 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.

**To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.** 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. AND 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.

• Knowledge of the following: o ICD-10, CPT and HCPCS coding experience and/or certification. o Federal and state laws and rules governing RACs and UPICs o Minnesota Health Care Programs, and specifically Medicaid o Fee-for-service and managed care programs o Medicare program and how it interacts with the Medicaid program o Third party liability and benefit recovery principles o Minnesota Medicaid Information System (MMIS) and the Data Warehouse o Minnesota Medicaid claims processing and coding systems o Analytic tools and data mining to identify Medicaid misbilling, overpayments, and fraud o 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.