Lead Provider Investigator / Human Services Program Consultant

When all employees are embraced, respected and heard, we will build a collaborative, equitable, inclusive and anti-racist culture where everyone thrives.

Job Details

Working Title: Lead Provider Investigator
Job Class: Human Services Program Consultant
Agency: Human Services Dept

• Job ID: 79919
• Location: St. Paul
• Telework Eligible: Yes
• Full/Part Time: Full-Time
• Regular/Temporary: Unlimited
• Who May Apply: Open to all qualified job seekers
• Date Posted: 09/03/2024
• Closing Date: 09/12/2024
• Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office
• Division/Unit: Department of Human Services (DHS) / Office of Inspector General (OIG) SIRS Provider Invest 4
• Work Shift/Work Hours: Day Shift / 8:00 a.m. - 4:30 p.m.
• Days of Work: Monday - Friday
• Travel Required: Yes
• Salary Range: $35.43 - $52.53 / hourly; $73,977 - $109,682 / annually
• Classified Status: Classified
• Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE
• FLSA Status: Exempt - Administrative
• Designated in Connect 700 Program for Applicants with Disabilities : Yes

The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

Job Summary

*This position is currently eligible for full-time telework, but occasional travel and possible onsite work will be required. Telework allows an employee to perform work from a telework location and an employee may be required to be in the office based on business needs and other dependencies in St. Paul, Minnesota. Only candidates located in Minnesota and bordering states (Iowa, North Dakota, South Dakota, or Wisconsin) are telework eligible.

*Approximately, 5% travel.

This position exists to provide health, accounting, law enforcement and/or criminal justice system experience to combat waste, mismanagement, misuse, fraud, and criminal corruption in the Minnesota Medical Assistance program. The employee will function independently and as a member of a medical, financial, or investigation team, in training, 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, lead and mentor other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, s anctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers or medical services to clients of Medical Assistance. These functions are the major responsibilities of this position.

Qualifications

Minimum 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.**

Three (3) years of 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, theft, and abuse by pro viders.

Experience must demonstrate the following:

• Investigation of cases and problem resolution within limitations set by regulations, law and policy.
• Access, extract, manipulate and present data in different formats to support investigative activities.
• Create and update policies, procedures and guidance for investigations and train staff on policies and procedures.
• Mentor and train new investigative staff.

Preferred Qualifications

• Must be able to research, interpret, and apply provisions from the federal Code of Federal Regulations (CFR), state statute and rule, and DHS policy as it pertains to Minnesota's health care delivery and payment systems, as well as Medicaid Provider Audits and Investigations (MPAI) authority and functions.
• Apply a broad-based, comprehensive understanding of federal and state health care policy, rules, laws, and requirements that allow for making and/or denying payment of claims adjudicated by the Medicaid claims processing system.
• Expertise in the data warehouse, SAS, and other analytical tools.
• Writing legal and technical documents, i.e., Notices of Agency Action, correspondence, policies, procedures, and statistical/fiscal information.
• Apply strong customer service skills while performing the regulatory functions of the job.
• Knowledge of medical terminology and coding.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

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.

REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.

Application Details

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

If you have questions about the position, contact Brian Pieh at brian.pieh@state.mn.us .

To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Carolyn Rice at carolyn.rice@state.mn.us .

If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services' ADA Coordinator at 651-431-4945 or DEPARTMENT OF HUMAN SERVICES_ADA@state.mn.us for assistance.

About Human Services Dept

WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.

Working together to improve the state we love.

What do Minnesota's State employees have in common?

• A sense of purpose in their work
• Connection with their coworkers and communities
• Opportunities for personal and professional growth

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.

Your benefits may include:

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
  • Fertility care, including IVF
  • Diabetes care
  • Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care
• Resources that provide support and promote physical, emotional, social, and financial well-being

Support to help you reach your career goals:

• Training, classes, and professional development
• Tuition reimbursement
• Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov )

Employee Assistance Program (EAP) for work/life support:

• A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
• Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
• Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care

Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

EQUAL OPPORTUNITY EMPLOYERS

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. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, 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.