Business Operations Specialist 2026-02373

State of Wyoming•Cheyenne, WY

1d•Onsite

About The Position

The Business Operations Analyst will serve as an integral part of the Program Integrity (PI) team. In this position, a successful candidate will support PI goals and initiatives to minimize fraud, waste, and abuse in Wyoming’s state Medicaid system. The Business Operations Analyst will be responsible for activities related to the Annual Single Statewide Audit of the Medicaid program and will assist in overpayment recovery activities. The Business Operations Analyst will receive and track provider payments and facilitate the delivery of documentation to relevant partners.

Requirements

Knowledge of State and federal government functions, procedures, policies, rules, and laws.
Knowledge of Medicaid functions, procedures, policies, rules, and laws.
Knowledge of technology and systems in use by the department.
Knowledge of audit and investigation processes.
Knowledge of fraud and abuse detection methods and systems.
Knowledge of State Personnel Rules.
Knowledge of basic database creation and management.
Knowledge of basic statistical compilation and analysis.
Knowledge of operation of all current and commonly used office technology, such as office and cell phones, computers, copy machines, and faxes. Ability to apply this usage to the organization of work tasks.
Skill in research and analysis of complex problems, identification of options and solutions, evaluation of results, and decision-making.
Skill in process, procedure, and policy development and implementation.
Skill in interpreting and participating in fiscal reporting.
Skill in public speaking and oral and written communication to varied audiences on complex and controversial issues.
Ability to establish and maintain positive working relationships with internal and external individuals and groups.
Ability to accept and be flexible with Federal, State, and Agency changes.
Ability to balance multiple demands on time and resources.
Ability to self-educate, both formally and informally, to remain current in areas of responsibility.
Bachelor's Degree (typically in Human Services)
0-2 years of progressive work experience (typically in Benefits and Eligibility) with acquired knowledge at the level of a Quality Assurance Specialist OR 3-5 years of progressive work experience (typically in Benefits and Eligibility) with acquired knowledge at the level of a Quality Assurance Specialist

Nice To Haves

An Associate's degree or higher in Accounting or a related field
Experience in database creation and management
Experience in financial management and payment tracking

Responsibilities

Manage the annual Single Statewide Audit (SSA) activities for the Medicaid program, coordinating with DHCF staff, medical record reviewers, fiscal staff, contractors, providers, and external auditors.
Develop and maintain internal procedures to support audit compliance, including document management, claims submissions, records requests, and other Program Integrity audit activities.
Compile, organize, track, and submit required audit documentation, provider information, claims data, certified mail receipts, and provider responses within established deadlines.
Manage provider outreach related to audit records requests, including follow-up with non-responsive providers, case creation, and appropriate recovery actions.
Coordinate with Utilization Management contractors on medical necessity reviews and compile review documentation for auditors and DHCF leadership.
Gather and communicate audit findings to DHCF leadership and provide recommendations for process or program improvements when appropriate.
Manage Program Integrity payment processing, including provider payments, overpayments, credit balance recoveries, account updates, and the return of federal funds in accordance with applicable requirements.
Coordinate with Benefits Management System contractors, fiscal staff, and other partners to ensure payments are accurately tracked, documented, and applied to provider accounts.
Support payment plans, provider payment suspensions and terminations, settlement enforcement actions, and Administrative Hearing preparation, including documentation and deadline tracking.
Maintain accurate financial information within the Fraud, Waste, and Abuse system and compile documentation supporting Program Integrity administrative and recovery actions.
Develop and maintain fiscal reports covering payments, recoveries, credit balance aging, write-offs, fraud restitution, global settlements, and other financial activity while supporting compliance with federal funding requirements.
Compile and submit required fiscal reporting, including HealthStat data and the annual Medicaid Fraud Control Unit reconciliation report.