Medicaid Program Integrity Review Specialist - Human Services Program Specialist 1

Working Title: Medicaid Program Integrity Review Specialist

Job Class: Human Services Program Specialist 1

Agency: Human Services Dept

• Job ID: 999999999999999
• Location: St. Paul
• Telework Eligible: No
• Full/Part Time: Full-Time
• Regular/Temporary: Limited
• Who May Apply: Open to all qualified job seekers
• Date Posted: 05/19/2026
• Closing Date: 05/26/2026
• Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office
• Division/Unit: DHS-Central Office / BH Administration
• Work Shift/Work Hours: Day Shift / 8:00am to 4:30pm
• Days of Work: Monday - Friday
• Travel Required: No
• Salary Range: $23.98 - $34.69 / hourly; $50,070 - $72,432 / annually
• Classified Status: Unclassified
• Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE
• End Date: 12/01/2027
• FLSA Status: Nonexempt
• Designated in Connect 700 Program for Applicants with Disabilities: No
  
  

The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

• This posting will be used to fill five (5) temporary positions with State Benefits***
  
  

This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.

Flexible work hours may be permitted with supervisor approval.

We are hiring five (5) temporary Medicaid Program Integrity Review Specialists (18-month positions, with the possibility of extension). These roles are part of a new review team that will examine behavioral health services billed to Minnesota’s Medicaid program.

In this role, you will review clinical records and claims to make sure services meet program requirements and that public funds are used appropriately. The services you’ll review include Adult Rehabilitative Mental Health Services (ARMHS), Intensive Residential Treatment Services (IRTS), Peer Services, and Assertive Community Treatment (ACT).

You’ll work closely with teammates, a supervisor, and DHS policy experts in a collaborative environment. This is meaningful work that helps protect the integrity of Minnesota’s Medicaid program.

What You’ll Do:

Your day-to-day responsibilities will include:

• Review clinical documentation — including records submitted for prepayment review, focused claims review, and provider recertification — to verify that it is complete, accurate, and meets state and federal requirements.
• Apply clinical knowledge and Medicaid policy guidelines to make preliminary determinations about whether services were medically appropriate, claims are supported by documentation, and providers meet recertification standards.
• Collaborate with policy experts and program specialists to clarify requirements, work through complex cases, and ensure consistent application of review standards across the team.
• Maintain accurate records of your review activities to support audits, provider communications, and program oversight.
• Participate in ongoing training and quality improvement activities to stay current on behavioral health services, documentation standards, and review procedures.
  
  

Minimum Qualifications

Please make sure your resume clearly describes your experience in the areas listed below, including the start and end month/year for each position held.

One (1) year of high-level experience in a human services program that includes working with Medicaid providers along with meeting the required applicant work experience listed below.

OR

Three (3) years of advanced technical or paraprofessional practical experience in a human services program that includes working with Medicaid providers along with meeting the required applicant work experience listed below.

OR

Bachelor’s degree or higher in human services, social work, or a closely related field and two (2) years of advanced technical or paraprofessional experience to a human services program that includes working with Medicaid providers along with meeting the required applicant work experience listed below.

Required applicant’s experience must demonstrate:

• Working understanding of behavioral health conditions and treatment approaches.
• Experience understanding and applying Medicaid program rules and medical necessity concepts.
• Practical knowledge of clinical documentation standards and behavioral health service delivery systems.
• Familiarity with HIPAA, Minnesota data practices law, and confidentiality requirements for handling sensitive health information.
• Experience with or awareness of program integrity review methods (such as prepayment review, focused claims review, or provider recertification review), audit processes, fraud prevention, and Medicaid program integrity standards.
• A basic understanding of healthcare coding and billing as it applies to behavioral health services.
• Proficiency using computers for data entry and electronic documentation systems.
  
  

Preferred Qualifications

• Strong analytical and critical thinking skills — able to evaluate clinical documentation and identify issues.
• Excellent attention to detail, especially when reviewing records for discrepancies or missing information.
• Clear written communication skills for documenting findings in a professional, organized way.
• Ability to manage multiple reviews at once and prioritize effectively.
• Collaborative and interpersonal skills to work well with policy experts, providers, and team members from a variety of backgrounds and cultures.
• Ability to research, interpret, and apply policy updates and clinical guidelines.
• Experience with Medicaid claims platforms, electronic health record (EHR) systems, or reporting tools.
  
  

Additional Requirements

• Minnesota Department of Human Services(DHS) criminal background check will be conducted on all finalists for this position. Finalists must pass the DHS background check.
• Employee reference checks will be conducted on all finalists. This may include a review of documentation related to job performance. It also includes contact with the applicant's former employer(s).
  
  

How To Apply

Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers.

Contact

If you have questions about this position, contact Kristine Preston at kristine.preston@state.mn.us.

If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services’ ADA Coordinator at 651-431-4945 or DEPARTMENT OF HUMAN SERVICES_ADA@state.mn.us for assistance.

About Human Services Dept

WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.

Working together to improve the state we love.

What do Minnesota's State employees have in common?

• A sense of purpose in their work
• Connection with their coworkers and communities
• Opportunities for personal and professional growth
  
  

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.

Your benefits may include:

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
• Fertility care, including IVF
• Diabetes care
• Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care
• Resources that provide support and promote physical, emotional, social, and financial well-being
  
  

Support to help you reach your career goals:

Training, classes, and professional development

Tuition reimbursement

Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)

Employee Assistance Program (EAP) for work/life support:

• A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
• Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
• Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care
  
  

Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

EQUAL OPPORTUNITY EMPLOYERS

Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.

Applicants With Disabilities

Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.