Program Integrity Unit Investigator
Program Integrity Unit Investigator
Posted on :
04-07-2025
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
04-07-2025
Job Description
PLEASE ATTACH THE ADDITIONAL REQUIREMENTS LISTED AT THE BOTTOM OF THIS PAGE
Job ID: 31740
Agency: Department of Social Services Division of Medical Services
Location:Pierre or Sioux FallsSalary: $22.69 Hourly depending on qualifications
Pay Grade: H
Closing Date: 07/09/25
This is a Full-Time 40 Hours Weekly position with the Department of Social Services. For more information on DSS please visit .
The Division of Medical Services Program Integrity Unit is seeking a highly motivated individual to serve as Investigator for the South Dakota Medicaid Program. This position investigates suspected cases of fraud waste or abuse by current Medicaid providers and ensures payment benefits were not obtained illegally. This position gathers analyzes and presents sufficient evidence for departmental administrative actions or referral to the Medicaid Fraud Control Unit of the Attorney Generals Office. The desired candidate will possess a commitment to service the ability to compile and analyze healthcare data and the ability to utilize data for determining proper payment of South Dakota Medicaid claims. This is an in-office position.
The Ideal Candidate Will Have: Experience with data mining analytics and investigation procedures. Applicants with experience in medical coding Medicaid regulations and knowledge of health care reimbursement methodology are preferred. A bachelors degree is preferred but not necessary.
Knowledge of:
Skills and Ability to:
Additional Requirements: To be considered please attach your resume.
This position is eligible for Veterans Preference per ARSD 55:10:02:08.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.
The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays generous vacation and sick leave accrual dental vision and other insurance options and retirement benefits. You can view our benefits information at . This position is a member of Class A retirement under SDRS.
Must apply online:
You must apply online emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email:
An Equal Opportunity Employer
#LI-Onsite
Job ID: 31740
Agency: Department of Social Services Division of Medical Services
Location:Pierre or Sioux FallsSalary: $22.69 Hourly depending on qualifications
Pay Grade: H
Closing Date: 07/09/25
This is a Full-Time 40 Hours Weekly position with the Department of Social Services. For more information on DSS please visit .
The Division of Medical Services Program Integrity Unit is seeking a highly motivated individual to serve as Investigator for the South Dakota Medicaid Program. This position investigates suspected cases of fraud waste or abuse by current Medicaid providers and ensures payment benefits were not obtained illegally. This position gathers analyzes and presents sufficient evidence for departmental administrative actions or referral to the Medicaid Fraud Control Unit of the Attorney Generals Office. The desired candidate will possess a commitment to service the ability to compile and analyze healthcare data and the ability to utilize data for determining proper payment of South Dakota Medicaid claims. This is an in-office position.
The Ideal Candidate Will Have: Experience with data mining analytics and investigation procedures. Applicants with experience in medical coding Medicaid regulations and knowledge of health care reimbursement methodology are preferred. A bachelors degree is preferred but not necessary.
Knowledge of:
- Medicaid rules regulations and terminology;
- interviewing and investigative techniques;
- medical claims coding and processing;
- Microsoft Word Excel and Access;
- data mining procedures;
- effective methods of overpayment detection.
Skills and Ability to:
- write and communicate effectively and efficiently;
- effectively plan organize and prioritize work activities to meet schedules and deadlines;
- gather compile and analyze Medicaid claims data;
- analyze medical data to identify irregularities in the utilization of health services
- conduct in depth analysis of medical coding procedures
- document thoroughly and clearly the findings of investigations;
- assist with federal and state Medicaid audits;
- develop cooperation with Medicaid providers to resolve issues and collect overpayments;
- utilize computerized data systems;
- prepare clear and concise documentation reports and correspondence that reflect relevant facts;
- work independently with minimal supervision.
Additional Requirements: To be considered please attach your resume.
This position is eligible for Veterans Preference per ARSD 55:10:02:08.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.
The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays generous vacation and sick leave accrual dental vision and other insurance options and retirement benefits. You can view our benefits information at . This position is a member of Class A retirement under SDRS.
Must apply online:
You must apply online emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email:
An Equal Opportunity Employer
#LI-Onsite
Employment Type
Full Time
Key Skills
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