Program Integrity Unit Investigator

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 Falls

Salary: $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 https://dss.sd.gov/ .

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 General's 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 bachelor's 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 https://bhr.sd.gov/job-seekers/work-for-state-government/ . This position is a member of Class A retirement under SDRS.

Must apply online: https://gen-stateofsouthdako-trn.inforcloudsuite.com/hcm/xmlhttp/shorturl.do?key=1TO

You must apply online, emailed resumes or submissions will not be accepted.

South Dakota Bureau of Human Resources

Telephone: 605.773.3148 Email: careers@state.sd.us

http://bhr.sd.gov/workforus

"An Equal Opportunity Employer"