Minnesota Department of Human Services
Senior Investigator / Human Services Program Representative 2
Minnesota Department of Human Services, Saint Paul, Minnesota, United States, 55199
Join to apply for the
Senior Investigator / Human Services Program Representative 2
role at
Minnesota Department of Human Services
Agency Human Services Dept
Job Details
Job ID: 89660
Location: St. Paul
Telework Eligible: Yes
Full-time
Day Shift 8:00 a.m. - 4:30 p.m.
Travel Required: Yes
Salary Range: $32.40 - $47.76 hourly; $67,651 - $99,722 annually
Responsibilities This position exists to utilize healthcare, accounting, law enforcement, medical coding and/or criminal justice system experience to combat waste, mismanagement, misuse, and fraud in the Minnesota Medical Assistance program. The employee will function independently and as a member of an investigation team in developing and implementing strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions. In addition, the employee will plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse. The position requires the employee independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers for services to covered in the Minnesota Health Care Programs.
Minimum Qualifications
Three (3) years of experience using investigative techniques to detect fraud, abuse, over-utilization, and error in health care claims.
Develop criteria and parameters used to identify provider activity and potential cases for investigation.
Analyze fiscal and/or statistical and healthcare claims data to identify discrepancies.
Creation of investigative reports, referrals, and other materials for legal review and consideration in civil or criminal cases.
Conduct on-site visits for the purpose of obtaining additional information and documentation relating to cases under investigation in order to determine if billed services were actually provided as claimed and appropriately billed in accordance with applicable program provisions.
Preferred Qualifications
Global understanding of regulations, law and policy relating to health care services and work in-depth with provisions that directly relate to each given case.
Apply a broad-based, comprehensive understanding of federal and state health care policy, rules, laws and requirements that allow for submission and reimbursement of claims adjudicated the Medicaid claims processing system.
Resolve any problems relating to provider refusal to allow access to needed records.
Auditing and accounting experience.
Working Knowledge of MN DHS Licensed providers.
An understanding of claims processing operations, edits, and CPT coding practices sufficient to understand the procedures followed and decisions made by claims processing staff.
Skilled in writing legal and technical documents, i.e., Notices of Agency Action, correspondence, policies, procedures and statistical/fiscal information.
Interpret and apply complex policies, procedures, laws and regulations necessary to support the medical and/or legal issues of cases.
Working knowledge of Word, Excel and the basic computer programs used by Program Integrity and Oversight department.
Effectively communicate with persons involved in cases, minimizing conflict and de-escalating conflict should it arise.
Variety of experiences working effectively with others from different backgrounds and cultures.
Additional Requirements
Incumbent must possess and maintain a valid driver’s license.
Complete a background investigation prior to employment, including Criminal background check, Reference check, Fingerprinting check (MNJIS/CJIS).
Complete the CJIS Security Awareness training within 3 business days from the start of employment and successfully obtain/retain CJIS certification annually.
How To Apply Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers.
Contact Melanie LaBrie – melanie.labrie@state.mn.us
Equal Opportunity Employer Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex, gender identity, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.
Applicants With Disabilities Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.
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Senior Investigator / Human Services Program Representative 2
role at
Minnesota Department of Human Services
Agency Human Services Dept
Job Details
Job ID: 89660
Location: St. Paul
Telework Eligible: Yes
Full-time
Day Shift 8:00 a.m. - 4:30 p.m.
Travel Required: Yes
Salary Range: $32.40 - $47.76 hourly; $67,651 - $99,722 annually
Responsibilities This position exists to utilize healthcare, accounting, law enforcement, medical coding and/or criminal justice system experience to combat waste, mismanagement, misuse, and fraud in the Minnesota Medical Assistance program. The employee will function independently and as a member of an investigation team in developing and implementing strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions. In addition, the employee will plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse. The position requires the employee independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers for services to covered in the Minnesota Health Care Programs.
Minimum Qualifications
Three (3) years of experience using investigative techniques to detect fraud, abuse, over-utilization, and error in health care claims.
Develop criteria and parameters used to identify provider activity and potential cases for investigation.
Analyze fiscal and/or statistical and healthcare claims data to identify discrepancies.
Creation of investigative reports, referrals, and other materials for legal review and consideration in civil or criminal cases.
Conduct on-site visits for the purpose of obtaining additional information and documentation relating to cases under investigation in order to determine if billed services were actually provided as claimed and appropriately billed in accordance with applicable program provisions.
Preferred Qualifications
Global understanding of regulations, law and policy relating to health care services and work in-depth with provisions that directly relate to each given case.
Apply a broad-based, comprehensive understanding of federal and state health care policy, rules, laws and requirements that allow for submission and reimbursement of claims adjudicated the Medicaid claims processing system.
Resolve any problems relating to provider refusal to allow access to needed records.
Auditing and accounting experience.
Working Knowledge of MN DHS Licensed providers.
An understanding of claims processing operations, edits, and CPT coding practices sufficient to understand the procedures followed and decisions made by claims processing staff.
Skilled in writing legal and technical documents, i.e., Notices of Agency Action, correspondence, policies, procedures and statistical/fiscal information.
Interpret and apply complex policies, procedures, laws and regulations necessary to support the medical and/or legal issues of cases.
Working knowledge of Word, Excel and the basic computer programs used by Program Integrity and Oversight department.
Effectively communicate with persons involved in cases, minimizing conflict and de-escalating conflict should it arise.
Variety of experiences working effectively with others from different backgrounds and cultures.
Additional Requirements
Incumbent must possess and maintain a valid driver’s license.
Complete a background investigation prior to employment, including Criminal background check, Reference check, Fingerprinting check (MNJIS/CJIS).
Complete the CJIS Security Awareness training within 3 business days from the start of employment and successfully obtain/retain CJIS certification annually.
How To Apply Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers.
Contact Melanie LaBrie – melanie.labrie@state.mn.us
Equal Opportunity Employer Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex, gender identity, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.
Applicants With Disabilities Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.
#J-18808-Ljbffr