JOB
**This position is exempt from the State Human Resources Act** TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position. Division of Health Benefits employees with an approved hybrid telework schedule are currently expected to work onsite at their assigned duty station at least 4 working days per month or more as needed for business operations. Telework options are subject to change at the discretion of management. More information on this arrangement may be obtained at the time of interview. This position is based in North Carolina. This position is home-based. This position is expected to travel statewide for conferences and meetings as needed. This position will also be expected to attend meetings in Raleigh, North Carolina on a monthly or quarterly basis. Position SummaryThe goal of the NC Medicaid Office of Compliance and Program Integrity (OCPI) is to promote compliance with state and federal regulations and mitigate fraud, waste, and abuse in Medicaid. This position conducts reviews of recipient eligibility determinations in local Department of Social Services (DSS) offices to ensure that determinations for Medicaid programs are made accurately and in compliance with state and federal policy while identifying instances of errors for resolution. Job Specific ResponsibilitiesReview county Medicaid decisions for accuracy and timeliness of eligibility determinations and for application of eligibility policies and procedures in the denial and termination of benefits.Complete audit reviews to ensure that determinations for all Medicaid programs are made accurately and in compliance with policy while identifying instances of errors for resolutions.Verify eligibility factors for applicants and beneficiaries through contacts with businesses, federal and state agencies, and individuals with knowledge specific to the individual.Conduct face-to-face or telephone interviews with applicants/beneficiaries and financially responsible individuals, when required.Complete targeted reviews of eligibility cases for corrective action purposes in county departments of social services offices.Complete reports of findings for state and county staff and conduct meetings with county staff regarding findings of targeted corrective action record reviews.Make presentations to county departments of social services regarding audit review findings and documentation techniques.Analyze county performance and audit trends to propose and discuss internal control measures to mitigate recurring risk in the Medicaid eligibility process.Respond to questions from counties regarding audit errors and deficiencies.Review draft Medicaid policy changes and provide feedback to state staff.
EXAMPLE OF DUTIES
To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following: Experience communicating effectively with internal and external stakeholders.Considerable experience utilizing the NCFAST system to assess eligibility determinations in accordance with North Carolina Medicaid eligibility policy.Previous experience keying and determining eligibility for a Medicaid applicant or beneficiary and researching and verifying information provided by a Medicaid applicant or beneficiary.Proficiency in Microsoft Office programs such as Excel, Outlook, PowerPoint, and Word. Management Preferences: Previous and proven work experience at Division of Health Benefits/NC Medicaid.Familiarity with relevant and current NC Medicaid operations.Experience conducting second level reviews of Medicaid eligibility.Experience developing and/or conducting training on social services programs.Previous experience with NCTRACKS.
SUPPLEMENTAL INFORMATION
The North Carolina Department of Health and Human Services is an Equal Opportunity Employer. Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB). About NC Medicaid (Division of Health Benefits) The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees. 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, NC Medicaid Managed Care 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 $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries. Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment. Application ProcessApplicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity. To be under consideration for this vacancy, all applicants must complete an online application using this link: https://www.governmentjobs.com/careers/northcarolina. If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration. Due to the volume of applications received, we are unable to provide information regarding the status of your application. To check the status of your application, please log in to your GovernmentJobs.com account. You will either receive a call or email to schedule an interview or an email notifying you when the job has been filled. For technical issues with your application, please call the NeoGov Help Line at 855-524-5627. If there are any questions about this posting other than your application status, please contact us at Medicaid.Recruitment@dhhs.nc.gov.