Medicaid Audits & Investigations Compliance Officer

State of Iowa - Executive Branch; Des Moines (IA); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

Paid time off

Retirement plans

Flexible spending accounts

Life insurance

Long-term disability insurance

Employee assistance program

Employee discounts

Job summary

The State of Iowa - Executive Branch seeks a Compliance Officer to oversee Medicaid PI Audits and Investigations, ensuring program integrity and adherence to state and federal requirements. The role serves as the SME on audits for the Division and coordinates with the Iowa Attorney General's office.

Successful candidates will analyze data, identify risk areas, and recommend enforcement actions while maintaining strong cross‑agency relationships.

Qualifications

• Graduation from an accredited four-year college or university with a degree in any field and five years in investigative or closely related work.
• Graduation from an accredited four-year college or university with a degree in any field and five years of professional work involving enforcement of federal/state laws.
• Graduation from the accredited law school with two years of relevant experience.
• Total of nine years of education/experience as described above.
• Current continuous state executive branch experience including two years in management/supervisory roles.
• Current continuous state executive branch experience including eighteen months as Compliance Officer 1.

Responsibilities

• Oversee PI Audits and Investigations enforcement activities.
• Ensure compliance with federal and state laws, rules, and program requirements.
• Maintain liaison with the Iowa Attorney General's staff on cases and audits.
• Serve as SME on audits and investigations for the Division.
• Analyze reports and data, identify focus areas for audits.

Skills

Audits

Investigations

Compliance

Data analysis

Risk assessment

Communication

Education

Bachelor's degree (any field)

Juris Doctor (JD)

Nine years of education/experience equivalent

Tools

None

Job description

Job Description

The Medicaid Audits & Investigations Compliance Officer, under the supervision of the Program Integrity & Compliance Bureau Chief, is responsible to provide oversight of the Iowa Medicaid Program Integrity (PI) Audits and Investigations enforcement activities. Ensures the operations of the PI Audits and Investigations are compliant with federal and state laws, rules, guidelines and program requirements. Maintains liaison with the Iowa Attorney General's (AG) staff, confers on cases, audits or management activities referred for compliance or enforcement action. This position will serve as the operational and policy subject matter expert (SME) on audits and investigations for the Division.

Successful Candidates Will

• Analyze reports and interprets data results to identify focus areas for conducting compliance or program integrity audits.
• Recommend actions based on review of relevant facts, data, policies and information available.
• Applies critical thinking, using logic and reasoning to identify strengths and weaknesses of alternative solutions or approaches to problems.
• Evaluate areas of risk and identify recommended changes.
• Understand and interpret federal and state requirements and how those apply to state compliance.
• Communicate effectively to inform and foster productive relationships

Benefits

• 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.

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 .

All work performed on behalf of Iowa Health and Human Services must occur in the State of Iowa.

Minimum Qualification Requirements

• Graduation from an accredited four-year college or university with a degree in any field, and experience equal to five years of full-time work in investigative or closely related work which involved: preparing interpretative or administrative orders, rules, or regulations which have the effect of law; or interpreting and enforcing federal or state laws governing health care administration; or quality assurance review to determine, through internal audit or analysis, the level of compliance with program requirements; or drafting, negotiating, or examining contracts or related documents required for organizational operations.
• Graduation from an accredited four-year college or university with a degree in any field, and experience equal to five years of full-time, professional-level work involving the interpretation and enforcement of federal and state laws or department policies and procedures or quality assurance review as determined through internal audit or analysis of the level of compliance to program requirements.
• Graduation from accredited school of law and experience equal to two years of full-time work as described in number one or two or in the practice of law.
• A total of nine years of education and/or full-time experience (as described in number one, two, or three), where thirty semester hours of accredited college or university coursework in any field equals one year of full-time experience.
• Current, continuous experience in the state executive branch that includes experience equal to two years of full-time management/supervisory work in the interpretation and enforcement of federal and state laws or department policies and procedures or quality assurance review.
• Current, continuous experience in the state executive branch that includes experience equal to eighteen months of full-time work as a Compliance Officer 1.