Compliance Specialist 2

2 weeks ago

Helena, United States Montana Staffing Full time

Compliance Specialist 2 The Montana Department of Public Health and Human Services (DPHHS) has a career opportunity within the Office of Inspector General, Program Compliance Bureau. The Compliance Specialist 2 is responsible for identifying and investigating potential fraud, waste, and abuse within Montana Medicaid and Healthy Montana Kids (HMK) programs. Key duties include analyzing medical claims data, evaluating provider billing practices, and ensuring compliance with applicable state and federal regulations. The position requires interpreting healthcare policy, conducting provider interviews, calculating overpayments, and referring fraud cases to appropriate agencies. Additional responsibilities include educating providers on proper billing procedures, responding to inquiries, and maintaining comprehensive case documentation. Why Join DPHHS Our mission at DPHHS is serving Montanans in their communities to improve health, safety, well-being, and empower independence. By joining our department, you will have the opportunity to perform meaningful work in public service to our state and its residents. The State of Montana's comprehensive benefits package includes healthcare coverage, retirement plans, paid vacation, sick leave, and holidays, work/life balance, and eligibility to participate in the Public Service Loan Forgiveness (PSLF) program. In addition, DPHHS is the largest state agency with a wide range of advancement opportunities whether you are joining the workforce or have several years of experience. Qualifications for this Career Opportunity Knowledge of Medicaid rules, medical claims processing, medical terminology and coding principles and practices. Knowledge of reviewing, investigation, and research. Knowledge of Health Information Portability and Accountability Act (HIPPA) compliance. Ability to provide presentations to small groups. Ability to perform math calculations. Strong analytical and critical thinking skills. Meet minimum qualifications: Bachelor's degree in health sciences, health information, accounting, business, or social sciences related field. Two years of experience with medical claims, medical coding, or medical review of services. Other combinations of directly related education and experience may be considered on a case-by-case basis. Preferred: Coding certification through American Health Information Management Association (AHIMA) or American Academy of Professional Coder (AAPC). How to Apply To be considered for a DPHHS position, submit the following required documents with your application on the State of Montana Careers website. When submitting the required documents, you must check the "relevant document" box to ensure your attachments are uploaded correctly to your application for this position. Cover Letter Resume Successful applicants will be subject to background checks relevant to the position and must pass reference checks before an offer will be extended. DPHHS is an equal opportunity employer. Women, minorities, and people with disabilities are encouraged to apply. For a copy of the full job description or if you need a reasonable accommodation in the application or hiring process, contact DPHHS Human Resources listed below. Location: Helena

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