PROVIDER ELIGIBILITY AND COMPLIANCE SPECIALIST - HUMAN SERVICES PROGRAM SPECIALIST 1

• Working Title: Provider Eligibility and Compliance Specialist
•

• Job Class: Human Services Program Specialist 1
•

• Agency: Human Services Dept
•

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• Job ID
• : 81442

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• Location
• : St. Paul

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• Telework Eligible
• : Yes

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• Full/Part Time
• : Full-Time

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• Regular/Temporary
• : Unlimited

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• Who May Apply
• : Open to all qualified job seekers

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• Date Posted
• : 10/30/2024

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• Closing Date
• : 11/082024

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• Hiring Agency/Seniority Unit
• : Human Services Dept / MAPE DHS Central Office

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• Division/Unit
• : Health Care Administration / Medicaid Payment and Provider Services

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• Work Shift/Work Hours
• : Day Shift / 8:00am - 4:30pm

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• Days of Work
• : Monday - Friday

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• Travel Required
• : No

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• Salary Range:
• $22. 61 - $32. 71 / hourly; $47,209 - $68,298 / annually

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• Classified Status
• : Classified

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• Bargaining Unit/Union
• : 214 - MN Assoc of Professional Empl/MAPE

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• FLSA Status
• : Nonexempt

+ Designated in Connect 700 Program for Applicants with Disabilities ( : Yes

The Department of Human Services 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.

This team is currently teleworking; however, this may change in the future with notice

This position is a Minnesota Health Care Programs (MHCP) Provider Eligibility and Compliance Specialist in the Medicaid Payments and Provider Services (MPPS) Provider Eligibility and Compliance unit interpreting and applying internal, state, and federal requirements for determining the eligibility and enrolling counties, health care providers, provider groups and other health care entities into Minnesota Health Care Programs. The incumbent will report to a supervisor and team leads. This position may interact with a variety of provider types, and may need to contact various entities for information relating to provider credentials.

• Main responsibilities includes:
•

+ Research, analyze, interpret, and apply internal, state, and federal requirements for determining the eligibility of and enrollment of counties, health care providers, provider groups and other health care entities providing services to enrollees in the Medicaid program.

+ Read, apply, and update, procedural documents using programs such as, Microsoft Word, Outlook, and Excel.

+ Monitoring continued provider eligibility and compliance, and taking necessary action to prevent payments to providers who are not eligible for reimbursement.

+ Ensure data is entered accurately into the enrollment system and consistently document actions taken.

+ Respond to provider inquiries by phone within 1-3 business days.

+ Meet with providers in person, through web conferencing, and conference calls.

+ Periodically interact with a diverse population that may require use of language line or other systems for communication and accessibility.

+ Provide consultation on updating and creating services and enrollment record types. May assist with system updates and testing.

+ Accurately process a large volume of applications on a daily basis.

+ Analyze complex issues and process applications for variety of provider types.

+ Ability to work independently and as part of a team.

+ Complete repetitive tasks and other duties as assigned.

• Minimum Qualifications
•

Two (2) years advanced administrative support, paraprofessional, or technical experience in a healthcare or social services setting.

• OR
•

Associates degree in related field and one (1) year advanced administrative support, paraprofessional or technical experience in a healthcare or social services setting.

• OR
•

Bachelor's degree.

• AND
•

Experience must demonstrate:

+ Ability to research, compile, gather information and/or communicate with stakeholders

+ Applying understanding of internal, state, federal and/or national rules, regulations, or procedures

+ Flexibility in tasks

+ Skills and ability to work with diverse populations

+ Professionalism in receiving and giving feedback

+ Basics in Microsoft Office programs

• Preferred Qualifications
•

+ Familiarity with MN Healthcare Programs (MHCP), which includes Medical Assistance (MA), General Assistance Medical Care (GAMC), and/or MinnesotaCare (MNCare).

+ Understanding of Provider Eligibility and Compliance enrollment process and provider manual

+ Experience or understanding of MHCP systems and/or MN-ITS (A secure web based platform that is used to access MPSE Portal and for electronic billing of claims to MHCP)

+ Ability to participate and demonstrate strong team skills while also able to work independently

+ Enrolling individual or organizations into a system or program while verifying other databases or experience utilizing multiple systems at the same time to complete a task

• 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.

AN EQUAL OPPORTUNITY EMPLOYER

Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.

Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-#-# or email . @state. mn. us . Please indicate what assistance is needed.