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Coordinator of Program Integrity in Managed Care

2 months ago

Marquand, Missouri, United States State of Indiana Full time
Position Overview:
This role, Managed Care Program Integrity Coordinator, is tasked with overseeing and managing the operations of the State's Managed Care Entities (MCE) Special Investigation Units (SIU) to effectively address issues of fraud, waste, and abuse within the Indiana Medicaid system.

Key Responsibilities:
- Act as the coordinator for the Program Integrity Provider Review Committee (PIPRC), which evaluates referrals to ascertain if a Credible Allegation of Fraud (CAF) has been identified.
- Serve as the primary liaison for the Program Integrity team's Fraud Abuse Detection System (FADS) contractor concerning MCE SIU matters.

Qualifications:
The ideal candidate will possess a bachelor's degree in healthcare administration, informatics, public health, public administration, or a related field, accompanied by five years of relevant experience. A graduate degree or prior experience in Health Maintenance Organizations (HMO) is preferred. Additionally, credentials in health information/coding or auditing (e.g., RHIA, RHIT, CCS, CCS-P, CPC, or CFE) along with experience in utilization review, coding, or retrospective medical claim auditing are highly desirable.

Essential Functions:
The essential functions of this role include:
  • Establishing and monitoring program objectives, key performance indicators (KPIs), and actions to achieve them.
  • Directing, planning, or implementing policies and activities to ensure ongoing operations and enhance productivity.
  • Interpreting and explaining policies, regulations, or laws to various stakeholders.
  • Recommending and implementing corrective action plans to address program issues.
  • Preparing reports for approval, including those related to funding or service implementation.
  • Coordinating financial activities to optimize operations and enhance efficiency.
  • Ensuring compliance with federal and state policies and grant requirements.
  • Developing and training employees or agency consultants on program requirements.
  • Coordinating and delivering communication plans.
  • Participating in management committees and boards.
  • Recruiting, selecting, onboarding, and training employees to ensure clarity in role responsibilities and professional development opportunities.
  • Setting expectations, measuring progress, providing feedback, and evaluating employee performance.

What You'll Need for Success:
The successful candidate should minimally possess:
  • A Master's Degree with 3 years of experience, or
  • A Bachelor's Degree with 5 years of experience, or
  • An Associate's Degree with 7 years of experience, or
  • At least 9 years of relevant experience in a similar role.
Additionally, candidates must demonstrate:
  • Specialized knowledge in program subject matter through experience and/or education.
  • Extensive knowledge of provider agencies and their services.
  • Comprehensive understanding of federal and state laws governing the programs.
  • Ability to develop and implement new principles and policies.
  • Strong presentation skills for various audiences.
  • Analytical skills to evaluate information and identify optimal solutions.
  • Ability to collaborate effectively with diverse stakeholders.
  • Capability to prepare financial reports for program budgeting.
  • Skill in delegating tasks and managing workflow.
  • Proficiency in providing constructive feedback and coaching employees.

Benefits of Employment:
The State of Indiana offers a comprehensive benefits package for full-time employees, which includes:
- Multiple medical plan options with RX coverage, as well as vision and dental plans.
- Wellness Rewards Program with gift card incentives.
- Health savings account with state contributions.
- Flexible work scheduling options, including potential hybrid remote work.
- Deferred compensation plan with employer match.
- Fully-funded pension plan options.
- Generous leave policies, including paid new parent leave and community service leave.
- Education reimbursement programs.
- Group life insurance and employee assistance programs.
- Opportunities for professional development and free access to learning resources.

Equal Employment Opportunity:
The State of Indiana is committed to providing equal employment opportunities to all individuals, ensuring a diverse and inclusive workplace. We encourage applications from qualified individuals who possess the necessary skills for this position.