Medicaid Audits & Investigations Compliance Officer

State of Iowa; Des Moines (IA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, Dental, Vision

Paid Time Off

IPERS Retirement Plans

Flexible Spending Accounts

Life Insurance

Employee Assistance Program

Employee Discounts

Job summary

State of Iowa seeks a Compliance Officer for Medicaid Audits & Investigations to oversee enforcement activities, ensure program integrity, and coordinate with the Attorney General’s staff. The role serves as SME on audits and investigations within the Division.

The position requires reviewing procedures, assessing risks, and advising on compliance with federal and state requirements. Strong communication with internal and external teams is essential.

Qualifications

• Five years of full-time investigative or closely related work experience.
• Experience interpreting and enforcing federal and state health care laws or program requirements.
• Background in quality assurance review or internal audits to assess compliance.

Responsibilities

• Lead and coordinate Iowa Medicaid PI audits and investigations.
• Establish a QA program to promote integrity of program operations.
• Advise state Medicaid and vendor teams on compliance with federal/state laws.
• Coordinate external audits by state, vendors and managed care entities.
• Communicate findings and recommendations to stakeholders clearly.

Skills

Analytical thinking

Policy interpretation

Communication skills

Risk assessment

Education

Bachelor's degree

Law degree

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.

This key position will assess state and vendor PI audits and investigations procedures and processes that may present potential risks and vulnerabilities to the Iowa Medicaid program. Establish a quality assurance program that promotes operational and financial integrity of the Iowa Medicaid program's internal operations. Confer with AG staff and advise state Medicaid and vendor teams on state and federal compliance and legality of procedures. Lead and coordinate Iowa Medicaid state, vendor and managed care entity teams audits and investigations. This position will lead and coordinate external entity federal and state audits of the Iowa Medicaid program.

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

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.

For additional information on benefits.

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 visitwww.e-verify.gov.

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

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 with a degree in any field,andexperience equal to five years offull-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.