Medicaid Surveillance Administrator
4 weeks ago
Introduction
Make a Difference with DHSS
Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.
We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.
For more information, please visit today
Summary Statement
This position reports to a Social Services Chief Administrator and ensures that recipients and providers comply with Medicaid regulations. Duties: supervise fiscal audits, assure excessive payments are recovered, develop and revise statewide Medicaid policy and procedure, oversees identification of abuses of the Medicaid Program, assure compliance with federal regulations and State Plan requirements, conduct policy and fiscal impact analysis, write reports, executive summaries, legal documents and draft legislation for review by Deputy Director, represent the agency with presentations and serving on committees, works with regional/state/national Medicaid Fraud Control Units, attorneys, medical professionals, licensing authorities, the Welfare Fraud Unit, and outside organizations.
Essential Functions
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here. Supervises the conduct of complex medical utilization and financial audits of providers and recipients for the State's Medicaid Program. Plans, advises, supervises, formulates work plans, assesses and evaluates methods and productivity for the unit. Supervises and monitors the "Restricted Recipient" Program by developing policies, standards and methods for identifying abusers of Medicaid services and ensuring corrective action is taken to control utilization by recipients. Supervises the maintenance of accounting records for recovery of overpayments for Medicaid Program statewide. Writes/monitors/negotiates contractual agreements. Collects, analyzes, reviews, and evaluates information provided by contracted services, audit firms and professional review organizations in order to assess compliance with quality care, financial regulations and Medicaid criteria. Develops, implements and supervises computerized systems for various components of Medicaid Program. Assesses current operations and regulation requirements for enhanced computerization. Supervises the investigation of and responses to complaints from providers, clients, etc.
Job Requirements
JOB REQUIREMENTS for Medicaid Surveillance Administrator
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Conditions of Hire
Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
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