What are the responsibilities and job description for the Program Integrity Bureau Chief position at State of Iowa - Executive Branch?
Job Description
The Iowa Department of Health and Human Services (HHS), Division of Medicaid, Bureau of Program Integrity is seeking a Bureau Chief to join our team!
The Bureau Chief of Program Integrity is responsible for Medicaid Program Integrity including, but not limited to, medical necessity reviews, federal and state audits and investigations, member and provider exclusions and sanctions, monitoring of over payments, provider enrollment oversight, payment integrity accountability and recovery, coordination of Medicaid fraud, waste, and abuse, and payment error rates measurements.
Performs research, making presentations and developing or supervising the development of technical papers in order to assure that Medicaid program integrity policy and federal compliance operations are understood by key policy makers and others.
Promptly and accurately communicates information about all issues impacting the operation of the Bureau, including federal policies, changes in state law, stakeholder interests, and emerging trends, or concerns/issues identified by peers, Deputy Medicaid Director, and Medicaid Director; lead efforts to anticipate issues and facilitate resolution.
Provide communication in a myriad of formats to meet information demands emanating from DHS staff, legislators, advocates, providers, or others and adjust communications to the varied audience.
Manage, coordinate and direct the activities of the Program Integrity staff to ensure that program policy and reporting and submission requirements are understood, organized, and implemented in a timely and effective manner and the appropriate communications and coordination with both internal staff and external partners occur.
Develop and implement policies and procedures to assure consistent, accurate, and timely monitoring and analysis of all program integrity aspects of the Managed Care Organizations (MCO) and Fee-for-Service (FFS) programs. Policies and procedures will assure the Centers for Medicare and Medicaid Services (CMS) and state requirements are met and reflect best practice standards.
Comprehends State and Federal Medicaid regulation and reporting requirements. Applies health care planning principles to resolve complex administrative, operational and budgetary issues, and initiates appropriate procedural or policy changes to prevent re-occurrences. Participates in bill reviews and policy development.
Benefits
Working for the State of Iowa comes with its perks. In addition to a competitive salary, you'll enjoy a comprehensive benefits package designed to support your well-being and professional growth:
Click here to see how we compare with other employers or offers by using our Total Compensation Calculator.
Background Checks
Applicants will be required to complete a background check to be considered for this position.
The State of Iowa is an EEO/AA Employer
HHS values those with “lived experience” and encourages adults who were fostered as youth, foster parents, and/or parents who were in the DHS system to apply. Minorities, women, persons with disabilities and veterans are encouraged to apply (Hearing and Speech Impaired – Relay Iowa 1-800-735-2942 TDD).
E-Verify and Right to Work
The State of Iowa participates in E-Verify, a federal program that helps employers confirm the employment eligibility of all newly hired employees. Within the required timeframe, new hires will be verified through the E-Verify system to ensure authorization to work in the United States. The State of Iowa also complies with the federal Right to Work laws, which protect employees’ rights to work without being required to join a labor organization. For more information, please visit www.e-verify.gov .
This is a non-merit position with the Health & Human Services - Medicaid . Candidates must follow the instructions in the "To Apply" section.
Positions in this class are exempt from the screening and referral requirements of the Iowa Department of Administrative Services - Human Resources Enterprise.
Minimum Qualification Requirements
Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification:
The Iowa Department of Health and Human Services (HHS), Division of Medicaid, Bureau of Program Integrity is seeking a Bureau Chief to join our team!
The Bureau Chief of Program Integrity is responsible for Medicaid Program Integrity including, but not limited to, medical necessity reviews, federal and state audits and investigations, member and provider exclusions and sanctions, monitoring of over payments, provider enrollment oversight, payment integrity accountability and recovery, coordination of Medicaid fraud, waste, and abuse, and payment error rates measurements.
Performs research, making presentations and developing or supervising the development of technical papers in order to assure that Medicaid program integrity policy and federal compliance operations are understood by key policy makers and others.
Promptly and accurately communicates information about all issues impacting the operation of the Bureau, including federal policies, changes in state law, stakeholder interests, and emerging trends, or concerns/issues identified by peers, Deputy Medicaid Director, and Medicaid Director; lead efforts to anticipate issues and facilitate resolution.
Provide communication in a myriad of formats to meet information demands emanating from DHS staff, legislators, advocates, providers, or others and adjust communications to the varied audience.
Manage, coordinate and direct the activities of the Program Integrity staff to ensure that program policy and reporting and submission requirements are understood, organized, and implemented in a timely and effective manner and the appropriate communications and coordination with both internal staff and external partners occur.
Develop and implement policies and procedures to assure consistent, accurate, and timely monitoring and analysis of all program integrity aspects of the Managed Care Organizations (MCO) and Fee-for-Service (FFS) programs. Policies and procedures will assure the Centers for Medicare and Medicaid Services (CMS) and state requirements are met and reflect best practice standards.
Comprehends State and Federal Medicaid regulation and reporting requirements. Applies health care planning principles to resolve complex administrative, operational and budgetary issues, and initiates appropriate procedural or policy changes to prevent re-occurrences. Participates in bill reviews and policy development.
Benefits
Working for the State of Iowa comes with its perks. In addition to a competitive salary, you'll enjoy a comprehensive benefits package designed to support your well-being and professional growth:
- Health, Dental, and Vision Coverage: Health and dental insurance packages to keep you and your family healthy at a low cost with outstanding coverage!
- Paid Time Off: Take time to recharge with paid time off, including vacation (96 hours/year to begin, increasing with years of service), sick leave (144 hours/year), and paid holidays (9 days/year).
- Retirement Plans: Participate in retirement plans such as IPERS (employees contribute 6.29% and the State of Iowa contributes 9.44%) as well as our Retirement Investors Club (RIC), Employer Sponsored Retirement Plan (the State of Iowa matches dollar for dollar up to $75/month).
- Flexible Spending Accounts: Take advantage of flexible spending accounts for medical and dependent care expenses.
- Insurance Coverage: Benefit from life insurance and free long-term disability insurance for added peace of mind.
- Employee Assistance Program: Access resources and support through our Employee Assistance Program for personal and professional challenges.
- Employee Discount Programs: Enjoy discounts on a variety of goods and services through our employee discount programs.
Click here to see how we compare with other employers or offers by using our Total Compensation Calculator.
Background Checks
Applicants will be required to complete a background check to be considered for this position.
The State of Iowa is an EEO/AA Employer
HHS values those with “lived experience” and encourages adults who were fostered as youth, foster parents, and/or parents who were in the DHS system to apply. Minorities, women, persons with disabilities and veterans are encouraged to apply (Hearing and Speech Impaired – Relay Iowa 1-800-735-2942 TDD).
E-Verify and Right to Work
The State of Iowa participates in E-Verify, a federal program that helps employers confirm the employment eligibility of all newly hired employees. Within the required timeframe, new hires will be verified through the E-Verify system to ensure authorization to work in the United States. The State of Iowa also complies with the federal Right to Work laws, which protect employees’ rights to work without being required to join a labor organization. For more information, please visit www.e-verify.gov .
This is a non-merit position with the Health & Human Services - Medicaid . Candidates must follow the instructions in the "To Apply" section.
Positions in this class are exempt from the screening and referral requirements of the Iowa Department of Administrative Services - Human Resources Enterprise.
Minimum Qualification Requirements
Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification:
- Graduation from an accredited four-year college or university and experience equal to six years of full-time management-level work in finance, human resources, engineering, law, social work, regulation, data processing, or program research or evaluation.
- Ten years of full-time management-level work experience in finance, human resources, engineering, law, social work, regulation, data processing, or program research or evaluation.
- All of the following (a and b):
- Six years of full-time management-level work experience in finance, human resources, engineering, law, social work, regulation, data processing, or program research or evaluation; and
- A combination of a total of four years of education and full-time experience (as described in part a), where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience. Graduation from the Iowa Certified Public Manager Program is also equivalent to one year of full-time experience or education.
- All of the following (a, b, and c):
- Four years of full-time management-level work experience in finance, human resources, engineering, law, social work, regulation, data processing, or program research or evaluation; and
- A combination of a total of four years of education and full-time experience (as described in part a), where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience; and
- A combination of a total of two years of graduate-level education and full-time experience (as described in part a), where twenty-four semester hours of accredited graduate college or university course work in a public-service-related area (e.g., public or business administration, social work, law, education, engineering) equals one year of full-time experience. Graduation from the Iowa Certified Public Manager Program is also equivalent to one year of full-time experience or education.
- Current, continuous experience in the state executive branch that includes eighteen months of full-time work as a Public Service Manager 1 or comparable specific management-level position.