Job Information
Iowa Department of Administrative Services Medicaid Program Integrity Reporting & Coding Oversight Officer in Des Moines, Iowa
Medicaid Program Integrity Reporting & Coding Oversight Officer
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Medicaid Program Integrity Reporting & Coding Oversight Officer
Salary
$65,395.20 - $101,150.40 Annually
Location
Des Moines - 50319 - Polk County, IA
Job Type
Full-time
Job Number
24-03647
Agency
401 Health & Human Services - Central Office
Opening Date
04/25/2024
Closing Date
5/15/2024 11:59 PM Central
LinkedIn Tag
#LI-POST
Point of Contact
Courtney Bushell at cbushel@dhs.state.ia.us
Description
Benefits
Questions
Job Description
The Iowa Department of Health and Human Services (HHS), Iowa Medicaid Division, is seeking a Program Integrity Reporting & Coding Oversight Officer.
Medicaid is a state-federal funded program that is administered by the Iowa Department of Health and Human Services and is the second largest insurance program in the State of Iowa. Be part of an organization that is continually working to modernize and innovate solutions to improve the quality of life and health outcomes for the state’s Medicaid members.
The Program Integrity Reporting & Coding Oversight Officer, under the supervision of the Program Integrity & Compliance Bureau Chief, is responsible to ensure the integrity of the Iowa Medicaid program, as it applies to payments to providers. As the payment integrity subject matter expert (SME), this position analyzes and understands provider billings, manages risk of overpayment, and anticipates areas of program cost avoidance. This position is responsible for planning, implementation, and ongoing coordination of federal and State Medicaid
program integrity-related requirements in accordance with the Center for Program Integrity (CPI), the Centers for Medicare and Medicaid Services (CMS), and state law.
As the Division lead on the application of national coding requirements, this position will coordinate and lead the work of the agency’s national Correct Coding Initiative (CCI) vendors by evaluating the Agency's use of appropriate system edits to prevent improper payment of claims; monitoring coding quality and productivity metrics; and implementing improvement initiatives. Responsible to provide oversight of coding policies, procedures, and guidelines in accordance with relevant coding standards (i.e. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).
This key position will direct, guide, and evaluate the activities of the Program Integrity Unit Managed Care Plans Oversight (MCPO) Vendor in collaboration with other Division staff. In addition, this position will provide oversight of the Medicaid Managed Care Plans (MCPs) Program Integrity activities. This includes monitoring MCP reporting, developing monitoring standards, and reviewing MCP reports to identity trends, gaps and potential program vulnerabilities.
The Department is seeking candidates with experience in reviewing and processing public or private health care insurance claims. Those who possess a thorough understanding of medical insurance billing and coding practices and are proficient in reviewing and conducting claims research and analysis to resolve claim discrepancies to ensure billing accuracy and compliance within health insurance policy and industry standards are encouraged to apply.
Successful candidates will:
Comprehend and interpret federal requirements and how those apply to state compliance.
Prioritize work assignments to effectively meet deadlines.
Understand capitation rate setting, MMIS systems and HIPAA coding.
Analyze a variety of information to identify areas of non-compliance.
Identify complex problems, evaluate areas of risk then develop and evaluate options for compliance.
Communicate effectively to inform and foster productive relationships. .
Special Requirements:
Preference given to candidates with: Bachelor's degree in health care field; CMS ICD-10 and DRG coding experience; Coding Certification, such as Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC)
About Iowa HHS:
The Iowa Department of Health and Human Services (Iowa HHS) makes a positive difference in the lives of Iowans. Our mission is to help achieve healthy, safe, stable, and self-sufficient lives through the programs and services we provide. We have a great total compensation package for full-time employees, including:
Iowa Public Employees' Retirement System (IPERS)
Retirement Investors Club (RIC) (Employer Sponsored Retirement Plan)
Health, Dental and Vision Insurance
Vacation Leave
Sick Leave
Paid Holidays (9 days/year)
Flexible Spending Accounts
Life Insurance
Long-Term Disability Insurance
To learn more about benefits available to State of Iowa employees visit the benefits (https://das.iowa.gov/human-resources/employee-and-retiree-benefits/employees) web page.
Our agency uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify.
Minimum Qualification Requirements
Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification:
1) Graduation from an accredited four-year college or university with a degree in any field, and experience equal to four years of full-timeprofessional-level work in program administration, program development, program operations, or management.
2) A total of eight years of education and/or full-time experience (as described in number one), where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience.
3) All of the following (a, b, and c):
a. Two years of full-time professional-level work experience in program administration, program development, program operations, or management; and
b. A total of four years of education and full-time experience (as described in part a), where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience; and
c. A total of two years of graduate-level education and full-time experience (as described in part a), where twenty-four semester hours of accredited graduate college or university course work in a public-service-related area (e.g., public or business administration, social work, public health, law, education, engineering) equals one year of full-time experience. Graduation from the Iowa Certified Public Manager Program is also equivalent to one year of full-time experience or education.
4) Current, continuous experience in the state executive branch that includes twelve months of full-time work as an Executive Officer 1 or comparable specific management-level position.
Why Choose the State of Iowa?
At the heart of our commitment to excellence is a dedication to our most valuable asset – our employees. Discover the outstanding benefits that set us apart as an employer of choice.
Our Robust Benefits Package Includes:
Competitive Compensation:
Enjoy a competitive salary that reflects directly on your skills and expertise.
Keep in mind, your wage is just one part of your total compensation. Unlock the complete value of your employment with the State of Iowa by using our user-friendlyTotal Compensation Calculator (https://das.iowa.gov/media/3773/download?inline) .Gain insights into your comprehensive annual compensation, including salary and State-provided benefits.
Health and Wellness:
Prioritize your well-being with our comprehensive health plans, including medical, dental, and vision coverage. Enjoy the peace of mind knowing that the State of Iowa covers 90% of the premiums, providing you and your loved ones with excellent coverage at a remarkably low cost.
Retirement Planning:
We are proud to offer the Iowa Public Employees Retirement System (IPERS). A defined benefit plan, IPERS benefits are guaranteed for life, meaning once you retire, you will receive the same monthly benefit for the remainder of your life (once vested). We invest in your long-term financial well-being, so you can retire with peace of mind.Click here to learn more about IPERS (https://ipers.org/members) .
Paid Time Off:
Life is unpredictable, and at the State of Iowa, we understand the importance of work-life balance. Our leave policies, including paid holidays, vacation, and sick leave with unlimited accrual, ensure you have the flexibility you need for personal and family matters.
Professional Development:
Elevate your career with continuous learning opportunities. We support your growth through training programs, workshops, and tuition reimbursement.
Employee Assistance Program (EAP):
We care about your well-being beyond the workplace. Access confidential counseling, resources, and support through our Employee Assistance Program.
Diversity and Inclusion:
Be part of a diverse and inclusive workplace that embraces all backgrounds and perspectives. We believe diversity is a strength that drives innovation.
Join Us - Elevate Your Career:
Ready to elevate your career with the State of Iowa?Click here (https://iowa.attract.neogov.com/recruitment/p/benefits) to explore more about our unparalleled benefits and discover what makes us unique. Your success is our priority!
01
Do you understand that the answers to all of the following questions must be truthful, honest, and accurate to the best of your ability? Please read all questions and answers thoroughly and make sure you understand them completely.Ensure the answers to your questions match the information filled out on your application and the attachments you have uploaded. If the answers to your questions are inconsistent with your application information or uploaded attachments, you will be given zero points for the question.Knowingly misrepresenting the facts when submitting any information related to an application, examination, certification, appeal, or any other facet of the selection process will result in your disqualification from this application and future employment with the state of Iowa.
Yes - I understand and agree.
No
02
PLEASE READ CAREFULLY
Have you filed a registration statement pursuant to the federal Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. §611 et seq?
No - I have NOT filed a registration statement pursuant to the federal Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. §611 et seq
Yes - I HAVE filed a registration statement pursuant to the federal Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. §611 et seq
03
Have you graduated from an accredited four year college or university? IF YES- How many years do you have of full-time professional level work in program administration, program development, program operations, or management?
I have not graduated from an accredited four year college or university
Less than two years of the identified experience
Two years to less than four years of the identified experience
Four years or more of the identified experience
04
How many years do you have of COMBINED post high school education AND/OR experience in full-time professional level work such as program administration, program development, program operations, or management? 30 semester hours equals one year of experience.
I do not have any of the education and/or experience
Less than four years of the combined education and/or experience
Four years to less than eight years of the combined education and/or experience
Eight years or more of the combined education and/or experience
05
Have you graduated from the Iowa Certified Public Manager Program?IF YES- How many years do you have of COMBINED post high school education AND/OR experience in full-time professional level work such as program administration, program development, program operations, or management.? 30 semester hours equals one year of experience.
I have not graduated from the Iowa Certified Public Manager Program
Less than four years of the combined education and/or experience
Four years to less than seven years of the combined education and/or experience
Seven years or more of the combined education and/or experience
06
Have you graduated from an accredited four year college or university? IF YES - How many years do you have of COMBINED GRADUATE level (post bachelor's degree) course work in a public-service-related area (e.g., public or business administration, social work, public health, law, education, engineering) AND/OR full-time professional level work such as program administration, program development, program operations, or management? Twenty-four hours of the identified graduate level course work equals one year of experience. A MAXIMUM of 48 semester hours of graduate course work may be counted.
I have not graduated from an accredited four year college or university
Less than four years of the combined graduate education AND/OR experience
Four years or more of the combined graduate education AND/OR experience
07
Are you a current State of Iowa employee? IF YES - How many months do you have of continuous experience in the state executive branch as an Executive Officer 1 or a comparable management level position?
I am not a State of Iowa employee
Less than 12 months of experience as an Executive Officer 1 or a comparable management level position
12 months or more of experience as an Executive Officer 1 or a comparable management level position
Required Question
Agency
State of Iowa
Website
http://dhs.iowa.gov/
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