Provider Eligibility and Compliance Representative - Team Lead / Human Services Program Representati

Working Title: Provider Eligibility and Compliance Representative - Team Lead

Job Class: Human Services Program Representative 1

Agency: Human Services Dept

• Job ID : 80036

• 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 : 09/06/2024

• Closing Date : 09/16/2024

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

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

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

• Days of Work : Monday - Friday

• Travel Required : No

• Salary Range: $28.82 - $42.31 / hourly; $60,176 - $88,343 / annually

• Classified Status : Classified

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

• 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.

Minnesota Health Care Programs (MHCP) enrolls more than 75 types of individual and organizational providers to serve our recipients and receive payment for those services. More than 250,000 individual and organizational providers are enrolled, required to sign provider agreements, and abide by and accept state and federal policies to receive payments. Each provider type is unique and must meet specific criteria to enroll.

The Team Lead, provides a leadership role on a team that is responsible for processing enrollment applications from health care providers, health plans, counties and tribes who are requesting to enroll as a Minnesota Health Care Programs (MHCP) provider. This position will interpret and apply federal and state requirements for determining the eligibility of and enrolling counties, health care providers, provider groups and other health care entities into Minnesota Health Care Programs MHCP.

The incumbent will be the subject matter expert (SME) for the team. The person in this role will process applications, business changes, and other items as determined by business needs. The position will train and advise staff providing information and enrollment-related customer service supports. Take rotations with other Team Leads to complete tasks such as but not limited to CRM (short for Microsoft Dynamics CRM), processing appeals, payment withholds, consolidations, and others as assigned.

Job Responsibilities Include:

• Lead in the development and implementation of health care operational policies, industry initiatives related to Provider Relations, Provider Enrollment production support, new growth, and state and federal mandates.

• Handle and resolve complex to highly complex inquiries, problems and decisions related to Provider Relations and Provider Enrollment and resulting reports and data analysis.

• Coordinate the Provider Enrollment unit's compliance with the Medicaid Integrity Audit, the OLA Audit and PERM.

• Work in collaboration with the unit Supervisor to engage in policy discussions. Research and initially draft recommended amendments and change proposals that pertain to provider eligibility. Test and assess the impact of proposed changes on different provider groups.

• Ensure that unit staff accurately interpret and use newly implemented criteria, processes, and practices used to determine and verify program eligibility, enroll providers, and monitor eligibility status. Notify the unit Supervisor of issues and needed corrective actions. Make staff training recommendations, if needed.

• Monitor the integrity and timeliness of decisions and data entered into the MPSE Portal and the MMIS Provider Subsystem.

• Assume responsibility for programs and projects, at the direction of the unit Supervisor, through the analysis, implementation and evaluation phases.

• Audit and evaluate enrollment progress reports. Perform data analysis and develop summaries and recommendations on programs and projects for the unit supervisor.

• Serve as, and represent, MHCP Provider Enrollment at various internal and external stakeholder meetings.

• Enroll MHCP providers as needed.

Minimum Qualifications

Two (2) years of professional experience working with Minnesota Health Care Programs (e.g.: Minnesota Care, medical assistance, home and community-based services) or health care programs.

Experience must demonstrate:

• Knowledge of the Minnesota/Health Care Programs (MHCP), including any of following: provider enrollment, provider screening and billing, eligibility and member enrollment, covered services and benefits policies.

• Experience in the health care provider industry, including an understanding of health care provider credentialing, claims processing, coding, or government program compliance.

• Project management skills with the ability to multi-task and advance activities throughout the project timeline.

• Experience leading a team or group in a deadline-driven environment or through a complex health care industry project.

*Bachelor's Degree or higher in human services, business, healthcare or related field may substitute one year of professional experience.

Preferred Qualifications

• Experience in health care programs with an emphasis on Medicaid/ Minnesota Health Care Programs.

• Strong communications skills, sufficient to translate technical information (medical and policy) into appropriate lay language.

• Understanding of theories and techniques of facilitating work groups and group decisions.

• Conceptualize and implement large-picture solutions that address more than one problem.

• Our employees are dedicated to ensuring cultural responsiveness. Preferred candidates will have a 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.

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 ~~~ or email ~~~ . Please indicate what assistance is needed.