Job Information
State of Wyoming Program Integrity Analyst & Technical Liaison 2024-02523 in United States
Program Integrity Analyst & Technical Liaison 2024-02523
Print (https://www.governmentjobs.com/careers/wyoming/jobs/newprint/4714843)
Apply
Program Integrity Analyst & Technical Liaison 2024-02523
Salary
$32.52 Hourly
Location
Cheyenne, WY
Job Type
Contract Full-time
Job Number
2024-02523
Department
Department Of Health
Division
Cheyenne and County Offices
Opening Date
10/31/2024
Closing Date
Continuous
FLSA
Determined by Position
Job Classification
ATAW99
Description
Benefits
Questions
Description and Functions
Open Until Filled
GENERAL DESCRIPTION:
The Wyoming Department of Health, Division of Healthcare Financing (DHCF), Program Integrity (PI) Section is seeking a talented professional to join our team as a PI Analyst and Technical Liaison. This is an excellent opportunity for someone with strong organizational and problem-solving skills who is interested in building a career in the Medicaid audit, investigation, and compliance space.
The PI Analyst & Technical Liaison is responsible for managing complaints/referrals related to Medicaid provider and member fraud, waste, and abuse, will provide administrative and technical support across multiple units in the Program Integrity Section, and serve as the main liaison between the PI Section and key internal/external stakeholders.
This position is an At-Will Employment Contract (AWEC) and includes a single Health Insurance plan. This position pays for actual hours worked and is limited to 40 hours per week. This position does not include paid vacation time, paid sick time, paid holidays, family health insurance, retirement, or other benefits. These items are not negotiable by the hiring manager.
Human Resource Contact: wdhrecruit@wyo.gov
ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level.
Administrative Coordination
Send, receive, track, and manage certified correspondence related to audits, investigations, and other PI Section activities.
Process payments/checks and initiate/manage payment plans for administrative recoveries.
Receive, vet, distribute, and track telephone and web provider and member complaints/referrals related to potential fraud, waste, and abuse of Medicaid services.
Document & Case Management
Receipt and management of provider data, medical records, and other data from providers, as well as other sensitive information in the section’s case management system ensuring accuracy and efficiency in its receipt and organization.
Evaluate, manage, and conduct quarterly updates of PI’s extensive reference library, ensuring that federal and state statutes, administrative rules, regulations, policy manuals, bulletins, and education materials for providers are current and accessible.
Conduct scheduled and adhoc reporting from the fraud, waste, and abuse case management system and ensure that data is accurate and up to date.
Financial Management & Recovery
Process checks and financial transactions related to administrative recoveries, court-ordered restitutions, and global settlements.
Initiate and manage payment plans for administrative overpayment recoveries, tracking all financial transactions to ensure timely payments.
Functional/Operational Support
Support the operational functions of the PI Section by coordinating meetings, deadlines, and task tracking for audits, investigations, and other operational activities.
Provide research support for auditors, investigators, and other team members as required.
Monitor and report on compliance with Medicaid policies and procedures, as well as state and federal regulations, by keeping the team informed of relevant updates.
Stakeholder Liaison
Serve as the main liaison between the PI Section and key external stakeholders, including the Medicaid Fraud Control Unit, Utilization Management Coordinator, Unified Program Integrity Contractor, Healthcare Fraud Prevention Program, Benefits and Quality Control Managers, BMS contract manager, attorneys, and other relevant entities.
Respond to information requests from stakeholders.
Ensure compliance with Medicaid policies and procedures, as well as state and federal regulations by keeping the team informed of relevant updates.
Reporting Responsibilities
Generate regular and ad-hoc reports from the fraud, waste, and abuse case management system.
Compile and analyze data to identify trends, patterns, and areas of concern.
Prepare detailed reports for internal and external stakeholders, including summaries of findings, recommendations, and action plans.
Ensure timely and accurate submission of reports to relevant authorities and stakeholders.
Maintain comprehensive records of all reports and related documentation.
Qualifications
PREFERENCES:
Preference will be given to candidates with:
A High School Diploma or G.E.D. equivalent, with preference given to those candidates who have successfully completed college or technical degree programs related to the position (e.g., Accounting, Business, Criminal Justice, Paralegal, Public Administration, Healthcare Administration, Records Management, Data Analysis, or in a field of study that can be reasonably interpreted to perform tasks related to this position).
Minimum of 3 years of progressive work experience in an administrative or technical support role, ideally within a healthcare, legal, or government setting.
KNOWLEDGE:
Knowledge of state and federal government functions, policies, procedures, rules, and laws.
Strong critical thinking, organizational, and multitasking skills with attention to detail.
Skilled in professional written composition, technical writing, and verbal communication.
Experience handling sensitive information with discretion and maintaining confidentiality.
Ability to manage and analyze financial information.
Working knowledge and effective use of Microsoft Office Suite (Word, Excel, PowerPoint), Google platforms, and case management systems.
Knowledge of principles and practices of records and information management
Proficiency in data management and reporting tools.
Ability to work independently and as part of a team to solve problems, and streamline operational processes.
Ability to organize and prioritize responsibilities independently within established deadlines.
MINIMUM QUALIFICATIONS:
None - See "Preferences"
Necessary Special Requirements
PHYSICAL WORKING CONDITIONS:
- The employee may sit comfortably to perform the work; however, there may be some walking, standing, bending, carrying light items, driving an automobile, etc.
NOTES:
FLSA: Non-Exempt
The Wyoming Department of Health is an E-Verify (http://www.e-verify.gov/) employer.
Supplemental Information
048-Wyoming Department of Health - Division of Healthcare Financing
Clickhere (https://ai.wyo.gov/divisions/human-resources/consultative-services/compensation/pay-tables-salary-averages) to view the State of Wyoming Classification and Pay Structure.
URL:http://agency.governmentjobs.com/wyoming/default.cfm
The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.
Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.
Non Benefit Position