Full Job Description
The Triage Investigator is responsible for analysis, research, maintenance, and recording of complaints received by the Medicaid Restricted Recipient Program (MRRP) unit. This position is part of the Surveillance and Integrity Review Section (SIRS) - Restricted Recipient team which will identify, investigate, and take administrative or legal action in response to suspected over-utilization and/or abuse of the Minnesota Health Care Programs (MHCP) by recipients.
Triage Hotline calls to determine appropriate action to be taken
Assist the MRRP Supervisor, the SIRS Attorney, and the SIRS management team with legal and regulatory matters within SIRS and MRRP
Coordinate tracking of activities by SIRS which must be maintained for reporting obligations
Manage referrals to and from SIRS primary partners, including providers, contractors, other state agencies and federal agencies
Assist with gathering information and responding to data practices and discovery requests
Manage the files related to federal and state audits of SIRS and program integrity
Assist in file preparation and file management of Restricted Recipient Investigations
Conduct legal and subject matter research as needed
One (1) year professional experience in legal, human services or investigation of health care programs
Three (3) years of advance technical or paraprofessional experience in legal or Human Services
A Bachelor’s degree or higher in Human Services, Criminal Justice, Legal Studies, Nursing or related can substitute for 2 years of advance technical or paraprofessional experience.
Experience must demonstrate:
Investigative techniques and problem resolution skills
Experience with general computer use including spreadsheets, databases and word processing software
Experience interpreting and applying policies, procedures, laws, regulations, etc.
Bachelor’s degree or higher in legal studies or nursing
Experience with Minnesota Health Care Programs
Experience in health care claims
Experience researching, interpreting, and applying provisions from the federal CFR, state statute and rule, and policy as it pertains to health care delivery and payment systems
Experience using investigative techniques and problem resolution skills in order to manage the investigation and resolution of cases within limitations set by regulations, law and policy.
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.
Why Work For Us
GREAT BENEFITS PACKAGE! The State of Minnesota offers a comprehensive benefits package including low cost medical and dental insurance, employer paid life insurance, short and long term disability, pre-tax flexible spending accounts, retirement plan, tax-deferred compensation, generous vacation and sick leave, and 11 paid holidays each year.
Our mission as an employer is to actively recruit, welcome and support a workforce, which is diverse and inclusive of people who are underrepresented in the development of state policies, programs and practices, so that we can support the success and growth of all people who call Minnesota home.
How to Apply
Click "Apply" at the bottom of the page. If you have questions about applying for jobs, contact the job information line at 651-259-3637.
For additional information about the application process, go to http://www.mn.gov/careers.
If you have questions about the position, contact Jennifer Wenzler at Jennifer.firstname.lastname@example.org.
If you are a Connect 700 applicant, please email your certificate to Joua Aeling at Joua.Aeling@state.mn.us by the position close date.
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 DHS_ADA@state.mn.us for assistance.
AN EQUAL OPPORTUNITY EMPLOYER
The State of Minnesota is an equal opportunity, affirmative action, and veteran-friendly employer. We are committed to providing culturally responsive services to all Minnesotans. The State of Minnesota recognizes that a diverse workforce is essential and strongly encourages qualified women, minorities, individuals with disabilities, and veterans to apply.
We will make reasonable accommodations to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email email@example.com. Please indicate what assistance you need.