DVHA Programs and Operations Auditor

State of Vermont • Waterbury, VT

2d

About The Position

Provide investigative, analytical, and consultative work at a professional level for Department of Vermont Health Access (DVHA) involving health insurance and health care delivery systems. DVHA's Special Investigations Unit is seeking a Program and Operations Auditor to join their team to prevent fraud, waste, and abuse and help Vermont Medicaid recipients receive all the care and resources they need.

Work in a supportive work environment with a Monday-Friday schedule, eleven paid state holidays, in addition to a robust benefits package.

The Program and Operations Auditor Position has the following responsibilities:

Work in program integrity, quality control, and utilization review.
Continuing assessment (review) of health care systems and their design, development, implementation, and on-going operations.
Identification of unusual beneficiary and provider utilization patterns including procedural deficiencies in the reporting and claiming of reimbursement for services in these programs.
Extensive knowledge and interpretation of medical claims billing policies and practices and claims processing is essential.
Knowledge of revenue cycle, claims processing

Requirements

• Extensive knowledge and interpretation of medical claims billing policies and practices and claims processing is essential.
• Knowledge of revenue cycle, claims processing
• Graduate degree in public administration, finance, accounting, health insurance, or health care AND one (1) year or more at a professional level in a health/health insurance/human services program or organization.
• Bachelor's degree AND three (3) years or more at a professional level in a health/health insurance/human services program or organization.
• Associate's degree AND five (5) years or more at a professional level in a health/health insurance/human services program or organization.
• High School diploma or equivalent AND seven (7) years or more at a professional level in a health/health insurance/human services program or organization.
• Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Nice To Haves

• Medical Coding (preferred)

Responsibilities

• Work in program integrity, quality control, and utilization review.
• Continuing assessment (review) of health care systems and their design, development, implementation, and on-going operations.
• Identification of unusual beneficiary and provider utilization patterns including procedural deficiencies in the reporting and claiming of reimbursement for services in these programs.

Benefits

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 11 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED