Departmental Specialist 13 - HS ENROLLMENT AND PAYMENT INTEGRITY SECTION
About The Position
This position serves as the MI Coordinated Health Enrollment, Systems, and Payment (MICH ESP) Compliance Specialist within the Enrollment and Payment Integrity Section. The specialist is responsible for oversight and compliance activities related to Electronic Visit Verification (EVV) adoption and compliance monitoring, Exclusively Aligned Enrollment (EAE) compliance, and State Directed Payments (SDP) for Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs). The role is responsible for policy research, regulatory interpretation, and program analysis that inform operational decisions, compliance monitoring, and program integrity functions within the section. The position is a subject matter expert in federal and state statutes and regulations governing integrated care models, D SNPs, Medicare Advantage, and Medicaid managed care. This position is responsible for reviewing statutory and regulatory requirements across integrated care models, D SNPs, Medicare Advantage, and Medicaid managed care and applying those rules to determine whether program operations are compliant. The specialist analyzes Medicaid Data Warehouse information, claims, encounter reporting, and payment adjudication outcomes to identify misalignments, flag non compliant activity, and initiate corrective actions. These responsibilities directly support accurate MICH enrollment processing and proper administration of State Directed Payments by ensuring issues are detected, evaluated, and resolved according to policy.
Requirements
- Possession of a bachelor’s degree in any major
- Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level.
- Relevant experience and/or education referred to in supplemental questions must be documented in resume, transcript and/or application to allow for accurate screening.
- Attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
- Attach a cover letter.
- If applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts. Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature.
- Failure to complete any of the above items may result in your application not being considered.
Nice To Haves
- Subject matter expert in federal and state statutes and regulations governing integrated care models, D SNPs, Medicare Advantage, and Medicaid managed care.
Responsibilities
- Oversight and compliance activities related to Electronic Visit Verification (EVV) adoption and compliance monitoring
- Exclusively Aligned Enrollment (EAE) compliance
- State Directed Payments (SDP) for Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs)
- Policy research, regulatory interpretation, and program analysis that inform operational decisions, compliance monitoring, and program integrity functions
- Reviewing statutory and regulatory requirements across integrated care models, D SNPs, Medicare Advantage, and Medicaid managed care and applying those rules to determine whether program operations are compliant
- Analyzing Medicaid Data Warehouse information, claims, encounter reporting, and payment adjudication outcomes to identify misalignments, flag non compliant activity, and initiate corrective actions
Benefits
- Employees will be provided computers to perform state work.
- Phones may also be provided for necessary communications.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
