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Reimbursement Audit Specialist - Medicaid

Posting Begin Date: 2024/06/28
Posting End Date: 2024/07/28
Category: Business
Sub Category: Administration
Work Type: Full Time
Remote: Flexible Hybrid
Location: Boise, ID, United States
Minimum Salary: 29.87
Maximum Salary: 31.73
Pay Rate Type: Hourly

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Description


DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

***THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.

The Division of Medicaid is currently seeking a Reimbursement Audit Specialist with experience in Medicaid and/or other health care industry work, including government or commercial insurance health care backgrounds. The position is located in Boise’s Central Office. Candidates may request to telework, but telework is only available within the state of Idaho. No out-of-state telework requests will be approved. 

The Reimbursement Audit Specialist position supports the Bureau of Financial Operations within the Division of Medicaid. This position collaborates with other Medicaid bureaus and programs, a variety of external stakeholders, legislative partners, and other state agency divisions/programs. As a Reimbursement Audit Specialist, you will assist in the research, operations, and analysis of the provider reimbursement rate review and provider reimbursement rate review audits of home and community-based providers, institutional providers, long-term care providers, and long-term support services providers. The Reimbursement Audit Specialist will assist in reporting to the governor’s office, the legislature, department leadership, and other external stakeholders that provider reimbursement rate adjustments are sound and appropriate in supporting Idaho’s provider network. 

Additional projects the Reimbursement Audit Specialist may assist with include, but are not limited to, Medicaid 1115 and 1915 cost neutrality and financial support services to waiver creation, renewals, and demonstrations reports; state plan review and amendment assistance; conducting provider and external meetings with stakeholder groups; and reviewing and reporting on federal and state regulation changes to reimbursement and payment methodology.

BENEFITS:

BEST RETIREMENT AVAILABLE IN THE NATION 

We have one of the Nation's best state retirement systems (PERSI) that offers a lifetime benefit. 

OTHER EXCELLENT BENEFITS

  • 11 paid holidays
  • Generous vacation and sick leave accrual beginning as soon as you start 
  • Paid parental leave
  • Medical, dental, vision insurance - incredible rates!(full-time/30+ hours per week)
  • PERSI Choice 401(k)
  • Deferred compensation plan
  • Life insurance
  • Short and long-term disability insurance
  • Student Loan Forgiveness
  • Wellness programs
  • Employee Assistance Program (EAP)
  • Flexible Spending Accounts (FSA) 
  • Wide variety of training opportunities
  • Some positions offer flexible hours and/or telecommuting

EXAMPLE OF DUTIES:

The following are examples of duties assigned. The list is not exhaustive.

  • Lead, monitor, investigate, analyze, and model provider reimbursement rate adjustment activities, including reviews of a provider’s financial and utilization data, direct care worker wages, state-by-state program comparisons, and state and federal regulation compliance. 
  • Assist in the development of reimbursement rate adjustments, fiscal/budget request recommendations for leadership, and other financial-based projections to ensure adequate reimbursement for provider networks. 
  • Develop materials, interpret analyses, and report out on federal and state reimbursement/payment methodology updates for internal and external stakeholders. 
  • Work with internal and external stakeholders to develop strategies for state and federal compliance monitoring for reimbursement-related activities. 
  • Monitor independent contractor work on independent review, audit, and/or survey work for home and community-based and long-term support services activities. 
  • Support state plan and waiver development and maintenance activities for provider reimbursement activities. 
  • Complete other duties, tasks, or assignments as assigned by management.

MINIMUM QUALIFICATIONS AND SPECIALTY MINIMUM QUALIFICATIONS:

You must possess all the minimum and specialty minimum qualifications below to pass the exam for this position. Please make sure your resume or work history supports your meeting the minimum and specialty qualifications for this position. Failure to do this may disqualify you from being considered for this position. It is highly recommended to attach a one-page cover letter to your application to demonstrate how you meet the requirements below.

  • Good knowledge of project management. Typically gained by two years experience managing projects involved in determining project scope, developing project goals, timelines, budget, implementation strategies, and measurement methods, and monitoring progress toward goals and project completion.
  • Good knowledge of organizational/business analysis and evaluation. Typically gained by completing at least six semester hours of upper division college coursework for a degree in Business, Public Administration, Finance or other related field AND two years professional-level evaluative, analytical and planning work OR a Bachelor's degree in Business, Public Administration, Finance or other related field AND one year professional-level evaluative, analytical and planning work OR at least four years' work experience performing professional-level evaluative, analytical and planning work.
  • Good knowledge of process improvement methodology. Typically requires at least two years experience performing requirements discovery, process analysis, and preparation of reports and written documents.

SPECIALTY MINIMUM QUALIFICATIONS:

  • Good knowledge of social service programs serving the elderly and/or disabled, including social, economic, and health issues of the elderly and/or disabled; physical or biological sciences or related field. Typically gained by educational experience in a healthcare-related field OR by at least one year of demonstrated work experience.
  • Experience working with Medicaid or healthcare/healthcare insurance programs and researching and analyzing data for accuracy, trends, variances, and updates to ensure acceptable policies and procedures have been followed and for compliance with Federal and State laws and regulations in general and those related to Medicaid reimbursement and certain enrollment requirements. Typically gained by at least one year of demonstrated work experience. 

Below is preferred experience. It is not required for the position but applicants with this experience may receive consideration over other applicants.

  • Experience providing reports to leadership and management. Typically gained by one year of demonstrated work experience.
  • Experience working with financial accounting or auditing in health care providers and/or health care insurance programs. Typically gained by one year or more of demonstrated work experience.


Learn About a Career with DHW

***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 4:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:

Email is the quickest way to get an answer to your questions.

(answered Monday through Friday during business hours MST)

EMAIL: [email protected]

PHONE: (208) 334-0681

EEO/ADA/Veteran:

The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email [email protected].

Preference may be given to veterans who qualify under state and federal laws and regulations.

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