Medicaid Payments Program Integrity and Systems Coordinator / Human Services Program Consultant

Résumé du poste

The coordinator provides strategic guidance and oversight for Medicaid payment systems, ensuring operational compliance with federal and state regulations. They act as a subject matter expert, collaborating with IT and business stakeholders to modernize claims systems and prevent fraud, waste, and abuse.

Détails du poste

Working Title: Medicaid Payments Program Integrity and Systems Coordinator Job Class: Human Services Program Consultant Agency: Human Services Dept Job ID: 96921 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: 09/10/2026 Closing Date: 09/23/2026 Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office Division/Unit: DHS-Central Office / HCA MPPS Claims Ops Integrity Work Shift/Work Hours: Day Shift Days of Work: Monday - Friday Travel Required: No Salary Range: $36.59 - $54.25 / hourly; $76,399 - $113,274 / 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 This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework. 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 exists to provide advanced professional knowledge as a business owner and coordinator to provide guidance, prioritize, plan, lead, and support Medicaid’s efforts for its payment system maintenance, operations, development and implementation for multiple business areas within the Medicaid program so that it meets the needs of a wide variety of stakeholders. The person in this role serves as a Medicaid payments policy content expert and speaks on behalf of his/her administration in interactions with business architects, developers and other IT project leads to ensure that IT staff clearly understand their business, including its policies, programs and clientele and have timely information necessary to successfully maintain, operate, develop and modernize the claims payment IT system. He/she ensures compliance with federal and state policies, laws and regulations necessary to implement Medicaid program requirements. This Position Will Provide strategic and tactical guidance, support, and oversight of Medicaid payment activities and projects by developing, updating and implementing activities as they relate to system, policy, procedural or operational changes that occur as a result. Develop, direct and coordinate implementation of MHCP program integrity and compliance policies and, directives to ensure systems and operational procedures are compliant with all relevant federal and state statutes and regulations. Partner with DHS HCA, OIG and MFCU to set strategies for, develop, implement and oversee MPPS business unit efforts and claims payment system to apply pre-payment review activity in an effort to prevent of fraud, waste and abuse within the MHCP programs. Act as a subject matter expert on various complex issues and interactions among health care and other related programs MPPS operationalizes systems and policies necessary to process payment transactions for services provided through a wide array of programs and for external systems that utilize the data or information stored within the systems operated by the business units. Minimum Qualifications 3 years of professional experience with health care programs such as Minnesota Health Care Programs. Experience must demonstrate the following: Thorough understanding or ability to develop expertise in Minnesota Health Care Programs in a short time-frame Knowledge and experience with Medicaid policy, systems, benefits, and service delivery sufficient to understand how multiple computer systems operate, interact, and interface so that solutions are identified and system design problems are resolved Ability to organize and manage a broad spectrum of constituencies while addressing complex health care payment policies and goals Knowledge of and ability to adhere to DHS' policies, procedures, and protocol for handling its state legislative responsibilities and submitting documents for legislative application Ability to apply technical expertise in and extensive knowledge base relating to Medicaid and associated state and federal laws, policies, and regulations Ability to monitor, analyze, and advise on trends and developments related to payment policy Strong oral and written communications skills Preferred Qualifications Strategic planning and organization skills Problem solving ability that uses a logical, sequential approach Decision making Planning, organization, and time management skills Variety of experiences working effectively with others from different backgrounds and/or 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. 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 [email protected]. For additional information about the application process, go to http://www.mn.gov/careers. Contact If you have questions about the position, contact Kristin Gardner at [email protected]. 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 JaKeya Spencer at [email protected]. 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 [email protected] 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 [email protected] and let us know the support you need.

Ce que vous ferez

The coordinator provides strategic guidance and oversight for Medicaid payment systems, ensuring operational compliance with federal and state regulations. They act as a subject matter expert, collaborating with IT and business stakeholders to modernize claims systems and prevent fraud, waste, and abuse.

Exigences

Candidates must have at least 3 years of professional experience with health care programs like Minnesota Health Care Programs. Applicants must demonstrate a thorough understanding of Medicaid policy, systems, and the ability to manage complex stakeholder relationships.

Avantages

• Health insurance • Paid vacation • Sick leave • Paid holidays • Dental insurance • Vision insurance • Prescription drug plans • Fertility care • Diabetes care • Paid parental leave • Pension plan • Life insurance • Short-term disability insurance • Long-term disability insurance • Tuition reimbursement

Compétences indiquées

• Policy development · Souhaitée
• Analyse de données · Souhaitée
• Compliance · Souhaitée
• Gestion de projet · Souhaitée
• Stakeholder Management · Souhaitée

Autres compétences pertinentes

Relevées dans la description du poste. Confirmez les exigences importantes ci-dessus.

• Medicaid policy
• Program integrity
• Claims payment systems
• Strategic planning
• Compliance
• Systems maintenance
• Project management
• Data analysis
• Policy development
• Stakeholder management
• Technical communication
• Regulatory oversight
• Business architecture
• Fraud prevention
• Operational procedures

Domaines d’emploi

• Government & Public Sector
• Healthcare
• Social Services
• Technology
• Management & Leadership