Program Integrity Specialist (209140)

Job Description:

The Program Integrity Specialist (K0221996) Monitors and directs implementation of FFS utilization reviews of services provided to Medicaid consumers by selected providers. Reviews are completed by fiscal agent medical and policy analysts including RNs. Manages subsequent corrective action activities as determined when inadequacies or weaknesses are identified by fiscal agent utilization management (UM) provider reviews. Imposes sanctions on providers based on case reviews and investigations for the purpose of elimination of improper utilization of Medicaid funds. Assists the KDHE legal counsel in preparation of agency utilization review appeals and testifies on behalf of the agency as necessary. Manages fiscal agent SURS unit to direct resources where needed including oversight of assistance of MCO activity.

Job Responsibilities may include but are not limited to the following:

Directs implementation of monitoring and oversight activities to ensure KanCare MCO compliance with program integrity and contract requirements, including but not limited to: participation in annual desk reviews and on-site audits; review of applicable program integrity policies; facilitation of monthly meetings; and review and approval of monthly and quarterly program integrity reports.

Minimum Qualifications:

• Directs implementation of monitoring and oversight activities to ensure KanCare MCO compliance with program integrity and contract requirements, including but not limited to: participation in annual desk reviews and on-site audits; review of applicable program integrity policies; facilitation of monthly meetings; and review and approval of monthly and quarterly program integrity reports.

Education:

The minimum level of education and experience required to perform the job.

• Bachelor’s Degree

Licensing & Certification: 

• Valid Driver’s License – Incumbent is required to have and maintain a valid driver’s license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State.

Preferred Qualifications: 

Any additional skills, experiences, or qualifications that would be beneficial, but aren’t strictly necessary.

• Bachelor’s Degree in Political Science, Public Administration, Business, or a relatable field
• Master’s Degree in Political Science, Public Administration, Business, or a relatable field
• Word, Excel, PowerPoint, Access
• Proofreading, editing, attention to detail
• Independent judgment
• Advanced problems solving skills and analytical skills
• Communicate effectively both verbally and in writing
• Knowledge/interpret Medicaid rules and regulations
• Provide excellent customer service
• Knowledge of proper English, spelling, and grammar
• Analyze data and present in clear and concise reports
• Previous Medicaid experience and/or previous program integrity experience
• Previous Medicaid experience and experience with SURS and program integrity activities.
• Knowledge of proper English, spelling, and grammar.
• Experience with the Microsoft Office Suite.

About the Position: 

• Who can apply: Anyone (External)
• Classified/Unclassified Service: Unclassified
• Full-Time/Part-Time: Full-Time
• Regular/Temporary: Regular
• Work Schedule: Monday-Friday, 8am-5pm (Flexible schedules available)
• Eligible to Receive Benefits: Yes
• Veterans’ Preference Eligible: Yes

How to Apply:

Specific instructions for applying, which might include submitting a resume, cover letter, list of references, or completing an online application.

• Please include the Job ID number when emailing.

Job Application Process:  Only applications submitted within our State of Kansas Careers Portal will be considered.

• First Sign in or register as a New User at https://admin.ks.gov/offices/personnel-services/jobs
• Complete or update your contact information on the State of Kansas Careers Portal > My Contact Information page. *This information is included on all your job applications.
• Upload required documents listed for each specific job posting.
• Start your draft job application, upload other required documents, and Submit when it is complete.
  • Manage your draft and submitted applications on the Careers> My Job Applications page.
• Check your email and My Job Notifications for written communications from the Recruiter.
  • Email – sent to the Preferred email on the My Contact Information page
  • Notifications – view the Careers> My Job Notifications page

Contact Information:

[email protected]

Salary Range

$ $21.13 to $23.31