Program Integrity Coordinator Position Available In Wake, North Carolina

Program Integrity Coordinator State of North Carolina – Dept of Health and Human Services Wake County, NC Description of Work

• Position is Exempt from the State Human Resources Act – G.S. 126
• Position is funded in part through federal funds.

• PENDING RECLASSIFICATION

• POSITION

IS TIME-LIMITED

• Recruitment Range :

  $49,158.00 – $66,675.00 We will be recruiting for two (2) positions with this job posting: 65029277 and 65029278. Your application will be considered for both positions. This is a 100% remote position, although occasional travel and on-site in-person onsite work hours may be required .

• In North Carolina Medicaid, County Departments of Social Services perform the Medicaid program integrity function under the oversight of the State Medicaid agency.

Under the Social Security Act, Title XIX, Section 1909 and the Federal Regulations 42 CFR Part 455 entitled Program Integrity-Medicaid states the requirements for the control of fraud and abuse in the Medicaid program by the state Medicaid agency. The employee conducts preliminary reviews and investigation referrals of member fraud, waste, and abuse stemming from complaints received from citizens, legislators, Office of Inspector General (OIG), and Prepaid Health Plans (PHP). Employee conducts compliance monitoring of County DSS Fraud Plans by via on-site monthly visits. Employee conducts reviews of DSS Program Integrity processes and procedures to ensure compliance, efficiency, and accountability with identifying and addressing allegations of member fraud, waste, and abuse in accordance with federal requirements and state statutes. Employee implements the Centers for Medicare and Medicaid Services (CMS) fraud, waste, and abuse initiatives. Employee follows state and federal (CMS) regulations for quality control reviews, systematically reviews and evaluates test cases, and documents review findings in a database on each case. Employee verifies eligibility factors for members through contacts with businesses, federal and state agencies, and individuals with knowledge specific to the member. Employee reviews county performance reports and conducts follow-up with appropriate county staff, as well as: develops training webinars and modules for county Program Integrity staff; provides trainings and education at conferences, area meetings, and by phone; stays informed with policy changes and accuracy standards. Employee participates in work groups to create uniformity and standardization on specific processes and format for all Special Investigative Units (SIU) with Health Plans. Employee is responsible for implementing the State PI Compliance Monitoring Plan by conducting annual compliance reviews based on the plan scope and on a monthly basis and conducts collaborative compliance monitoring exit meetings with the county Program Integrity department based on the Compliance Monitoring Plan scope. About the

NC Division of Health Benefits:

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries. About the NC Department of Health and Human Services (DHHS): The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence.

Compensation and Benefits:

The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees. Visit website for benefits. Knowledge, Skills and Abilities / Competencies Listed below are the knowledge, skills and abilities (KSAs) associated with the position. These KSAs, along with the minimum education and experience listed, are required in order to be deemed “eligible” for the position therefore you must provide supporting information, within the body of your application, to demonstrate your possession of each KSA listed. Qualified applicants must possess, and application must clearly reflect work experience that demonstrates the following: Considerable knowledge of social services or Medicaid program areas to which assigned. General knowledge of all agency programs and services which could affect NC residents. Knowledge of or experience with researching, analyzing and interpreting Federal and State laws and formulate these laws into policies relating to social services and Medicaid programs. Documented experience with establishing and maintaining effective working relationships with staff from the Federal, State, and local agencies as well as beneficiaries, general public, and private service providers. Experience in compliance monitoring for overseeing and managing compliance testing on an organization’s day-to-day activities to ensure that compliance procedures and policies are working as intended to keep the business fully compliant with all regulatory requirements. Management preferences will be given to candidates with: Highly effective communication (oral and written) and analytical skills. Knowledge of the state’s NCFAST eligibility system. Working experience with

NCTRACKS.

Previous and proven work experience as an eligibility caseworker or program integrity investigator. Minimum Education and Experience Requirements Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See Education and Experience Equivalency Guide for details. Bachelor’s degree from an appropriately accredited institution and three (3) years of experience in the program related to the area of assignment; OR an equivalent combination of education and experience. Supplemental and Contact Information The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer who embraces an Employment First philosophy which consists of complying with all federal laws, state laws and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about

DHHS:

https://www.ncdhhs.gov/. DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position. It is critical to our screening and salary determination process that applications contain comprehensive information. Information should be provided in the appropriate areas to include the beginning and ending dates of jobs worked, education with the date graduated, all work experience, and certificates / licenses. Resumes will not be accepted in lieu of completing this application. Answers to Supplemental Questions must refer to education or work experience listed on this application to receive credit. Degrees must be received from appropriately accredited institutions. Applicants seeking Veteran’s Preference must attach a DD-214 Member-4 Form (Certificate of Release or Discharge from Active Duty) to their applications. Applicants seeking National Guard Preference must attach a NGB 23A (RPAS) if they are a current member of the NC National Guard in good standing. If a former member of the NC National Guard, who served for at least 6 years and was discharged under honorable conditions, they must attach either a DD256 or NGB 22. If applicants earned college credit hours but did not complete a degree program, they must attach an unofficial transcript to each application to receive credit for this education. Applicants may be subject to a criminal background check. All candidates selected for positions considered “Positions of Trust” will be subject to a criminal background check. Applications for positions requiring specific coursework must be accompanied by a copy of the applicant’s transcript. Applicants with degrees not conferred at a United States college or university must attach verification that their degree is equivalent to a similar degree from a U.S. institution. The Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent. For a list of organizations that perform this specialized service, please visit the NACES membership website at https://www.naces.org/members. Transcripts, degree evaluations and cover letters may be uploaded with your application.

NOTE:

Applicants will receive communication via email only for updates on the status of their application or any questions on their application. If there are any questions about this posting other than your application status, please contact Talent Acquisition at talentacquisition@dhhs.nc.gov. For technical issues with your application, please call the NeoGov Help Line at 877-204-4442. If you have a technical issue with your Government Jobs account, please call their Help Line at 1-855-524-5627.

NOTE:

For temporary, contract or other supplemental staffing appointments: There are no paid leave, retirement or other benefits associated with these appointment types.

For permanent and time-limited appointments:

Eligible employees have benefits that include employee health insurance options, standard and supplemental retirement plans, NC Flex (a variety of high-quality, low-cost benefits on a pre-tax basis), and paid vacation, sick, and community service leave, to name a few. Paid parental leave is available for eligible employees. Some benefits require 30 + hours work/week for participation.