Healthcare Auditor/Analyst (MAPS2/MPOI)
Company: Washington State
Posted on: March 24, 2020
(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
- Interviewing providers, provider staff, clients, and others, as
- Documenting specific findings identifying any improper payments
with conclusions based on rule, policy and billing
- 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
- Communicating recommendations and directives in the audit
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
Keywords: Washington State, Olympia , Healthcare Auditor/Analyst (MAPS2/MPOI), Professions , Olympia, Washington
Didn't find what you're looking for? Search again!