Working Title: Provider Eligibility and Compliance Specialist

Job Class: Human Services Program Specialist 1

Agency: Human Services Dept

• Job ID : 84152

• Location : St. Paul

• Telework Eligible : Yes

• Full/Part Time : Full-Time

• Regular/Temporary : Limited

• Who May Apply : Open to all qualified job seekers

• Date Posted : 02/13/2025

• Closing Date : 02/26/2025

• 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: $23.63 - $34.18 / hourly; $49,339 - $71,367 / annually

• Classified Status : Unclassified

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

• End Date : This position is expected to last less than 2 years.

• FLSA Status : Nonexempt

• Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : No

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 position is temporary and includes full state fringe benefits; the position is expected to last less than 2 years.

This posting will be used to fill multiple vacancies

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.

Responsibilities include:

• Analysis, interpretation and application of internal, state, federal and national requirements for determining the eligibility and enrollment of counties, health care providers, provider groups and other health care entities providing services to enrollees in the Medicaid program.

• Monitoring, review and verification of provider information to determine impact on eligibility, type, and level of reimbursement.

• Research and respond to inquiries regarding provider enrollment and compliance with policy, procedures and decisions. Research, draft and analyze findings of ad hoc studies and reports related to PEC policies and activities.

• Investigate, review and prepare recommendations for modifications, changes, and edits to systems, operations, policies and procedures.

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.

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.

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

• 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

• 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.

• Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

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 651-259-3637 or email careers@state.mn.us . Please indicate what assistance is needed.