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Healthcare Auditor/Analyst (MAPS2/MPOI)

Company: Washington State
Location: Olympia
Posted on: March 24, 2020

Job Description:

DescriptionHealthcare Auditor/Analyst (MAPS2/MPOI)OlympiaMultiple Positions*Please Note: This position is open until filled. Application assessment will be ongoing and the hiring authority reserves the right to offer the position at any time during the recruitment process. It is to the applicant's advantage to apply as early as possible. *This recruitment may be used to fill multiple positions.This is a dynamic role that will utilize both your expertise and ability to connect and communicate with people, as well as your foundation of technical experience and skills. The ideal candidate for this position will have experience with audits or reviews of healthcare claims. If you have supervisory or consultative experience in health services, social services or Medicaid programs, this opportunity may be for you!Position Objective:The Auditor/Analyst conducts data analysis of provider utilization profiles and audits, reviews and investigates Medical Assistance (MA) healthcare providers to identify potential fraud, waste and abuse. This position also works to recover related-improper payments, and refers credible allegations of fraud and quality of care/licensing issues to the appropriate authority.Some of what you will do:

  • Understanding managed care encounter data and determining areas that require program integrity oversight.
  • Designing and implementing audit strategies for performing provider payment reviews and managed care audits using independent judgment to formulate a plan of action and direction in complex audit scenarios;
  • Interviewing providers, provider staff, clients, and others, as indicated;
  • Documenting specific findings identifying any improper payments with conclusions based on rule, policy and billing instructions;
  • Utilizing DPI current Fraud and Abuse Detection Solution data analytic tools, case management program, and audit program to create audit universes and samples, make findings, and generate reports;
  • Communicating recommendations and directives in the audit report;
  • Mediating disagreements and disputes;
  • Formulating and recommending for implementation corrective action and/or administrative sanctions;
  • Participating in improper payment adjudication via ProviderOne or referring to the Office of Financial Recovery (OFR) and aiding OFR staff in overpayment collections as needed;
  • Coordinating case development, analysis, investigation, and prepares referrals to other agencies including, but not limited to the Assistant Attorney General's Office, Medicaid Fraud Control Unit and/or the Department of Health for appropriate action;
  • Representing HCA in providing expert testimony to explain and defend audit findings throughout the informal dispute process and the formal hearing process;
  • Responding to interrogatories and testifies at court proceedings; and
  • Representing HCA in providing expertise and claims review of contractor work to ensure findings are appropriate and supported by rule, policy and the Medicaid Provider Guides;
  • Preparing thorough administrative reports for providers, the Health Care Authority and other agencies.
  • Providing provider education throughout the audit process and as needed, participates in educational visits, meetings, teleconferences, presentations and/or webinars.
  • Providing technical assistance concerning the interpretation of health care policy and procedures, program analysis, and monitoring and improvement activities.
  • Participating in the writing or revision of publications such as Washington Apple Health Provider Guides and WAC.
  • Providing technical assistance to ProviderOne team by evaluating system edits as they pertain to audit finding to determine and recommend the creation of new or refinement of existing edit.Here is what we are looking for (Required Qualifications):A Master's degree with major study in public health, public administration, social work, or closely related field and two years of supervisory or consultative experience in health services, social services or Medicaid programs.(Two additional years of qualifying experience will substitute for the required Master's degree provided a Bachelor's degree has been achieved and additional qualifying experience may substitute year for year, for required education)OROne year as a Medical Assistant Program Specialist 1ORThree years as a Medical Assistance Specialist 4.AND
    • Working experience in audits or reviews of healthcare claims, i.e., licensed professional (physician, ARNP, dental), pharmacy, durable medical equipment, ambulance, behavioral health, home health services, nursing home.
    • Ability to extract imperfect data using tactics to make the information as objective as possible, and adjust analysis to reveal the best data.
    • Detail-oriented with the ability to understand the nuances and variables of data.
    • A curious disposition to explore and seek to understand data, with the drive and work ethic to find the truth in the data.Desirable/Preferred Qualifications:
      • Working knowledge of medical terminology and interpretation of health care documentation.
      • Working knowledge of ProviderOne, or other Medicaid Management Information System (MMIS).
      • Ability to lead teams and build consensus.
      • Knowledge of healthcare auditing concepts and principles.
      • Three years Medicaid or other healthcare-related field experience.
      • Working experience conducting medical record reviews and ability to interpret and apply Federal and State regulations, coding and billing requirements.
      • Proficient in the application of ICD-10, CPT, and HCPCS coding principles.
      • Demonstrated experience in data mining, data interpretation, and data analysis.
      • Proficient in the use of Microsoft software, including Word, Excel, and Access.
      • Knowledge of current and developing trends in medical healthcare delivery and billing.About the HCA:The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.What we have to offer:
        • Meaningful work with friendly co-workers who care about those we serveVoices of HCA
        • A clear agency mission that drives our work and is person-centeredHCA's Mission, Vision & Values
        • A healthy work/life balance, including alternative/flexible schedules and mobile work options.
        • Infants in the workplaceInfants at the Workplace Video
        • A great total compensation and benefit packageWA State Government Benefits
        • A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
        • Tuition Reimbursement
        • And free parking!About Olympia and Washington State:Washington State offers a total work/life package of pay, benefits, flexibility, and workplace opportunities to help you get the most out of your career and out of life. Washington State is a great place to work, play, and be a part of a community, offering quality of life that is unsurpassed. From the high energy urban center of Seattle, one of the nation's top ranked cities, to the more relaxed pace of our rural communities, Washington's distinctive Northwest lifestyle blends a progressive, creative culture with a casual nature.How to Apply:Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile and attach:
          • A cover letter that specifically addresses how you meet the qualifications for this position.
          • Current resume
          • Three professional referencesWashington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1761 or email Dennis.Lienemann@hca.wa.gov.*Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position. *Salary: $4,492.00 - $5,886.00 MonthlyLocation: Thurston County Olympia, WAJob Type: Full Time - PermanentDepartment: Health Care AuthorityJob Number: 2020-02894Closing: ContinuousAgency: State of WashingtonAddress: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504Phone: View Posting for Agency ContactWebsite: http://www.careers.wa.gov

Keywords: Washington State, Olympia , Healthcare Auditor/Analyst (MAPS2/MPOI), Professions , Olympia, Washington

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