Manager Medicaid Direct Investigations
Manager Medicaid Direct Investigations
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$ 67852 - 118741
1 Vacancy
Job Description
Description of Work
This is an Internal Posting open ONLY for current DHHS employees and eligible RIF Candidates from NC State Government To include eligible current Temporary Employees.
Position is funded in part through federal funds.
**Position is Exempt from the State Human Resources Act G.S. 126**
**Position is eligible for a hybrid remote teleworking schedule to include weekly onsite work hours.**
The Medicaid Direct Investigations Manager provides operational leadership for state staff and vendors conducting prepayment and postpayment reviews to detect fraud waste and abuse in the North Carolina Medicaid Direct program. This position manages a team of professional investigators and analysts with varied backgrounds who conduct claims and program compliance reviews to identify errors incorrect payments potential fraud or billing abuse in the program.
Job responsibilities will include:Facilitates the and maintenance of documented policies and procedures for NC Medicaids provider investigations operations.
Ensures Medicaid Direct Team (MDT) staff and payment integrity vendor activities and processes align with Federal and state rules and regulations for provider investigations and related program integrity requirements.
Facilitates monthly and quarterly vendor meetings to provide feedback to vendors on their performance of NC Medicaid payment integrity audits and investigations.
Liaise with the Medicaid Investigations Division (MID) legal counsel (e.g. DHB Attorney etc. and others as necessary for expert consultation clarification and/or approval of provider investigations and appeals strategies to include escalation of highpriority concerns or violations
Engage in personnel administration to include but not limited to recruiting coaching selecting and managing employees including disciplinary and termination actions as needed; delegating to staff members; encouraging and fostering professional development; establishing effective professional goals and work plan objectives.
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 wellbeing 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 108000 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 17000 employees. It is responsible for ensuring the health safety and wellbeing 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 highquality lowcost benefits on a pretax 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:Management preference will be given to candidates:Considerable knowledge of Special Investigation Unit activities and delivery systems.
Considerable understanding of contract oversight and monitoring.
Experience effectively managing personnel in the of provider audits and investigations.
Strong analytical and problemsolving skills including data analytics to understand provider trends and/or issues.
Experience managing personnel with diverse skill sets and the ability to mentor employees.
Proven ability to effectively supervise and motivate staff to accurately and effectively meet deadlines.
Demonstrated ability to plan and organize work and be flexible and adaptable to continually changing priorities.
Ability to develop and conduct staff training and programwide presentations.
Considerable knowledge of compliance monitoring program reviews resource management appeals records and documentation.
Thorough knowledge of North Carolina legislation regarding provider investigative processes and rights.
Proven experience interpreting and consulting on North Carolina Medicaid provider policy.
Experience leading a team of investigators and/or analysts.
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. SeeEducation and Experience Equivalency Guidefor details.
Masters degree in a disciple specific to the program from an appropriately accredited institution and four years of experience in the area of assignment including two years in a supervisory or consultative capacity; or
OR
Bachelors degree in a discipline specific to the program from an appropriately accredited institution and six years of experience in the area of assignment including two years in a supervisory or consultative capacity; or an equivalent combination of education and experience.
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: uses the MeritBased 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 Veterans Preference must attach aDD214 Member4 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 applicants 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 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 .
To check the status of an application please log in to your NC Government Job Opportunities account and click Application Status.
For technical issues with your application please call theNeoGov Help Line at. If you have a technical issue with your Government Jobs account please call their Help Line at.
Required Experience:
Manager
Employment Type
Full-Time
