Medicaid Provider Eligibility & Compliance Specialist

State of Minnesota; Saint Paul (MN); Hybrid; USD 50,000 - 72,000; Full time

Job summary

The State of Minnesota is seeking a Provider Eligibility and Compliance Specialist in St. Paul to screen, enroll and maintain provider records, ensuring compliance with state and federal requirements for MHCP providers.

The role supports Medicaid provider enrollment, eligibility determinations, and ongoing screening and licensure activities within the PEC team, collaborating with DHS/OIG and other agencies to prevent fraud and ensure program integrity.

Qualifications

• 2 years advanced administrative support, paraprofessional, or technical experience.
• Associate degree in related field and 1 year advanced administrative support, paraprofessional, or technical experience.
• Bachelor’s degree in related field.
• Experience with Medicaid provider enrollment process and eligibility criteria.
• Experience reviewing applications and determining eligibility.
• Experience with MPSE, MMIS or other claims processing subsystems.

Responsibilities

• Analysis, interpretation and application of internal, state, federal and national requirements for determining the eligibility and enrollment of counties, health care providers, provider groups and other health care entities providing services to enrollees in the Medicaid program.
• Monitoring, review and verification of provider information to determine impact on eligibility, type, and level of reimbursement.
• Research and respond to inquiries regarding provider enrollment and compliance with policy, procedures and decisions.
• Investigate, review and prepare recommendations for modifications, changes, and edits to systems, operations, policies and procedures.

Education

Associate degree in related field

Bachelor’s degree in related field

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

The State of Minnesota is seeking a Provider Eligibility and Compliance Specialist in St. Paul to screen, enroll and maintain provider records, ensuring compliance with state and federal requirements for MHCP providers.

The role supports Medicaid provider enrollment, eligibility determinations, and ongoing screening and licensure activities within the PEC team, collaborating with DHS/OIG and other agencies to prevent fraud and ensure program integrity.