Job Description
Working Title: Investigator OR Senior Investigator
Job Class: Human Services Program Representative 1 OR Human Services Program Representative 2 Agency: Human Services Dept - Job ID: 80913
- Location: St. Paul
- Telework Eligible: Yes
- Full/Part Time: Full-Time
- Regular/Temporary: Unlimited
- Who May Apply: Open to all qualified job seekers
- Date Posted: 10/10/2024
- Closing Date: 10/23/2024
- Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office
- Division/Unit: Department of Human Services (DHS) / Office of Inspector General (OIG) SIRS Prov Fraud Inv
- Work Shift/Work Hours: Day Shift / 8:00 a.m. - 4:30 p.m.
- Days of Work: Monday - Friday
- Travel Required: Yes
- Salary Range: $31.92 - $47.05 / hourly; $66,648 - $98,240 / annually
- Classified Status: Classified
- Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE
- FLSA Status: Nonexempt
- Designated in Connect 700 Program for Applicants with Disabilities: Yes
The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.
The work you'll do is more than just a job. At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.
- This position has a flexible work arrangement that may allow for Telework or a mixture of working in our office and Telework.
- Approximately 5% travel.
- This posting is used to fill multiple vacancies.
Human Services Program Representative 1 This position will apply knowledge and investigative expertise in order to identify, investigate, and take administrative or legal action in response to suspected fraud, over-utilization and/or abuse of the Minnesota Health Care Programs (MHCP) by enrolled providers.
Responsibilities include but are not limited to:
- Investigation of activities related fraud, abuse or over utilization by Minnesota Health Care Program providers.
Human Services Program Representative 2 This position exists to provide health, accounting, law enforcement and/or criminal justice system experience to combat waste, mismanagement, misuse, fraud, and criminal corruption in the Minnesota Medical Assistance program. The employee will function independently and as a member of a medical, financial, or investigation team, in training, developing, and implementing strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions. In addition, the employee will plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse.
Responsibilities include but are not limited to:
- Independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers or medical services to clients of Medical Assistance.
Minimum Qualifications Human Services Program Representative 1 Two (2) years professional experience with investigative techniques and problem resolution skills in order to manage the investigation and resolution of cases within limitations set by regulations, law and policy.
Experience must demonstrate the following:
- Understanding of the capabilities of automated computer systems and data bases and be able to access, extract, manipulate and present data in different formats to support investigative activities.
- Format, analyze, and prepare computer generated reports.
Incumbent must possess and maintain a valid driver’s license.
Human Services Program Representative 2 Three (3) years professional experience using investigative skills, an understanding of and the ability to apply the techniques used in the detection of fraud, abuse, and overutilization.
Experience must demonstrate the following:
- Understanding of claims, the processing operations, claims forms, edits, and coding structures.
- Analyze fiscal and statistical data and identify discrepancies or patterns.
- Developing and writing detailed legal and technical documents.
Incumbent must possess and maintain a valid driver’s license.
Preferred Qualifications - Understand the health care industry (institutional, community based and pre-paid plans), provider roles, and types of health care services, procedures, supplies, and pharmaceutical.
- Have a global understanding of regulations, law and policy relating to health care services and work in-depth with provisions that directly relate to each given case.
- Conduct on-site audits for the purpose of obtain additional information and documentation relating to cases under investigation in order to determine if billed services were actually provided as claimed and appropriately billed in accordance with applicable program provisions.
- Determine which federal and/or state laws, regulations and/or policies affect the case or cases being reviewed for each identified problem area.
- Present concise, well-written, factual, investigative reports, referrals, and other materials for legal review and consideration in civil or criminal cases.
- Using the data warehouse, audit and analytical tools, spreadsheets, and report functions generate information and develop report formats for monitoring provider billing practices and developing cases.
- Flexibility in order to respond and adapt to changes in priorities, operations practices, policies, procedures, laws, rules and coding systems - within a minimal time frame.
- Apply strong customer service skills while performing the regulatory functions of the job.
- Effectively communicate with persons involved in cases, minimizing conflict and de-escalating conflict should it arise.
- Variety of experiences working effectively with others from different backgrounds and cultures.
Additional Requirements 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.
How To Apply Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to
Contact
If you have questions about the position, contact Melanie LaBrie at Melanie.LaBrie@state.mn.us or Tinna Welter at Tinna.Welter@state.mn.us.
To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Carolyn Rice at carolyn.rice@state.mn.us.
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 DEPARTMENT OF HUMAN SERVICES_ADA@state.mn.us for assistance.
About Human Services Dept WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.
Working together to improve the state we love. What do Minnesota's State employees have in common?
- A sense of purpose in their work
- Connection with their coworkers and communities
- Opportunities for personal and professional growth
Benefits As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.
Your benefits may include: - Paid vacation and sick leave
- 12 paid holidays each year
- Low-cost medical, dental, vision, and prescription drug plans
- Fertility care, including IVF
- Diabetes care
- Dental and orthodontic care for adults and children
- 6 weeks paid leave for parents of newborn or newly adopted children
- Pension plan that provides income when you retire (after working at least three years)
- Employer paid life insurance to provide support for your family in the event of death
- Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
- Tax-free expense accounts for health, dental, and dependent care
- Resources that provide support and promote physical, emotional, social, and financial well-being
Support to help you reach your career goals:
- Training, classes, and professional development
- Tuition reimbursement
- Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)
Employee Assistance Program (EAP) for work/life support:
- A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
- Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
- Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care
Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.
EQUAL OPPORTUNITY EMPLOYERS Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.
Applicants With Disabilities Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.
Job Tags
Hourly pay, Holiday work, Full time, Temporary work, Part time, Local area, Remote job, Flexible hours, Shift work, Day shift, Monday to Friday,