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DEPARTMENT OF HUMAN SERVICES

Behavioral Health

Minnesota Association of Professional Employees (MAPE)

This positing will be used to fill five (5) open vacancies: (PTR#s: 146356 (Lead),146357, 146358, 146359, and 146360. Bidders: Please have an updated resume ready to submit to the hiring supervisor/manager when requested.

Date Posted:

11-12-2026

Date Closing:

11-18-2026

Posting Number:

146356

Job Classification:

Human Svcs Prog Rep 1

Class Option:

None

Employment Condition:

Full Time

Insurance Eligibility:

Full Employer Contribution

Division

Behavioral Health

Section

Program Integrity

Seniority Unit:

HCO - MAPE DHS Central Office

Work Location:

DHS CO Andersen

Supervisor:

Jen Sather

Supervisor Email:

jen.m.sather@state.mn.us

Recruiter:

Eastman,Maria Ellen

Recruiter Email:

Maria.Eastman@state.mn.us

General Description of Duties:

This position exists to serve as a principal staff specialist and subject matter expert in Medicaid program integrity for behavioral health services administered by the Behavioral Health Administration (BHA). The position conducts complex clinical and policy review of Medicaid claims through prepayment review and Centers for Medicare & Medicaid Services (CMS)–directed focused claims review of questionable claims across the full behavioral health continuum: substance use disorder (SUD) services, adult and children's mental health services, and integrated and co-occurring services. The incumbent interprets and applies federal and state statute, rule, the Medicaid State Plan, and program policy to independently determine whether services are allowable, medically necessary, clinically appropriate, and properly documented, and resolves the complex and ambiguous cases that fall outside established review procedures.

As BHA expands program integrity review to additional service areas, this position develops, applies, and modifies the review criteria, protocols, and policy guidance that govern that work; analyzes claims and review data to identify provider and systemic risk; identifies systemic program vulnerabilities to inform BHA substantive policy teams; translates statutory requirements into operational audit rubrics; and serves as a technical review resource to BHA leadership, review specialists, and agency partners. The position protects the integrity of Minnesota's Medicaid program, ensures appropriate use of public funds, and preserves access to medically necessary behavioral health care for Minnesotans who rely on it.

Some responsibilities include, but are not limited to:

-Conduct complex clinical and policy review of Medicaid behavioral health claims through prepayment review and CMS-directed focused claims review, independently determining whether services are allowable, medically necessary, and compliant with federal and state requirements, and resolving the complex, ambiguous, and precedent-setting cases that exceed established review procedures.
-Interpret regulatory requirements, develop and modify operational review protocols, and establish audit criteria for BHA behavioral health services to ensure determinations are legally defensible and consistent. 
-Plan, develop, and implement the expansion of Medicaid program integrity review to additional BHA service areas, serving as lead analyst for an assigned service portfolio and coordinating with BHA policy teams, Healthcare Administration (HCA), and Office of Inspector General (OIG).
-Analyze claims, review, and provider data to identify patterns of improper billing, provider risk, and systemic program vulnerabilities, and use findings to target review activity and inform policy and program decisions.
-Serve as a subject matter expert, policy resource, and technical consultant on behavioral health program integrity, providing specialized case consultation, clinical calibration, training, and technical assistance to review staff, internal partners, and providers. 
-Maintain complete and accurate program integrity records and documentation to support audits, appeals, CMS reporting, and program oversight.

Required Qualifications:

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.

Two (2) years of providing advisory-level work experience working with Medicaid-enrolled behavioral health providers and their billing and clinical staff regarding documentation requests, determinations, and technical assistance for human services program that demonstrate the following:  

-Experience with Minnesota's behavioral health service delivery system across SUD, mental health, and integrated services, including service standards, provider qualifications, and documentation requirements under Minnesota Statutes chapters 245G, 245I, 254B, and 256B and related rules.
-Practical understanding of Medicaid program integrity methods, including prepayment review, focused claims review, improper payment identification, risk-based targeting, and fraud, waste, and abuse indicators.
-Experience with Medicaid program requirements, including the Medicaid State Plan, the MHCP Provider Manual, medical necessity and coverage policy, and federal program integrity requirements (including 42 CFR Parts 455 and 456).
-Practical understanding of behavioral health coding and billing, including CPT and HCPCS codes, modifiers, and claims adjudication.
-Working knowledge of data privacy regulations: Minnesota Government Data Practices Act, HIPAA, and 42 CFR Part 2. 
*Bachelor’s degree or higher in human services, counseling, social work, or another related fields can substitute for one (1) year of required work experience.

Eligible bidders must be able to perform the essential functions of the job, with or without accommodations.

Per the MAPE bargaining unit agreement, you must be a permanent non-probationary MAPE employee in the same seniority unit, same classification, and same class option as this vacancy in order to submit an "interest bid". To interest bid, enter your employee ID: