Provider Eligibility and Compliance Specialist / Human Services Program Specialist 1

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

Working Title: Provider Eligibility and Compliance Specialist

Job Class: Human Services Program Specialist 1

Agency: Human Services Dept

• Job ID : 94311

• Location : St. Paul

• Telework Eligible : Yes

• Full/Part Time : Full-Time

• Regular/Temporary : Unlimited

• Who May Apply : Open to all qualified job seekers

• Date Posted : 11/06/2026

• Closing Date : 11/16/2026

• Hiring Agency/Seniority Unit : Human Services Dept / MAPE DHS Central Office

• Division/Unit : DHS-Central Office / HCA MPPS PEC HC Non Physician

• Work Shift/Work Hours : Day Shift

• Days of Work : Monday - Friday

• Travel Required : No

• Salary Range: $23.98 - $34.69 / hourly; $50,070 - $72,432 / annually

• Classified Status : Classified

• Bargaining Unit/Union : 214 - MN Assoc of Professional Empl/MAPE

• FLSA Status : Nonexempt

• Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes

This position is eligible for telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.

The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

This posting may be used to fill multiple vacancies.

This position exists to screen, enroll and maintain provider records to ensure State and Federal requirements are met to reduce Medicaid fraud, waste and abuse.

Minnesota Health Care Programs (MHCP) enrolls more than 70 types of individual and organizational providers to serve our recipients and receive payment for those services. More than 250,000 individual and organizational providers are enrolled and required to sign a provider agreement and abide by and accept state and federal policies and payments. Each provider type is unique and must meet specific criteria to enroll. Provider Eligibility & Compliance (PEC) is responsible for:

• Creating and maintaining provider enrollment criteria and procedures;

• Determining the eligibility of these providers;

• Processing initial enrollment applications;

• Working with these providers to maintain MHCP eligibility through ongoing screening, certification, and licensure and evolving program requirements

PEC is charged with managing and maintaining the data in the MMIS/MPSE provider subsystem. We partner with the DHS OIG, the Attorney General's (AG) office, and other state and federal agencies to maintain the integrity of our provider data and to prevent fraud, waste and abuse in our health care programs. PEC oversees the central repository of the supporting documentation that is required as proof in order to enroll MHCP providers.

The PEC Specialist responsibilities include:

• 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. Research, draft and analyze findings of ad hoc studies and reports related to PEC policies and activities

• Investigate, review and prepare recommendations for modifications, changes, and edits to systems, operations, policies and procedures

Minimum Qualifications

To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month, day and year for each job held.

2 years advanced administrative support, paraprofessional, or technical experience

OR

Associate degree in related field and 1 year advanced administrative support, paraprofessional, or technical experience

OR

Bachelor’s degree in related field

Experience must include the following:

• Experience with policies, procedures, and operations associated with Medicaid provider enrollment process and eligibility criteria

• Experience reviewing applications and determining eligibility

• Experience with MPSE, MMIS or other claims processing subsystems

Preferred Qualifications

• Understand and translate technical information into appropriate lay language

• Accurately and appropriately respond to sensitive and legally/politically volatile provider eligibility and compliance issues

• Handle complaints and apply good customer service techniques

• Effectively use standard office software, such as Microsoft Outlook, Word, and Excel

• Variety of experiences working effectively with others from different backgrounds and/or cultures

Additional Requirements

To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.

This position requires successful completion of the following:

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

• Criminal background check

• Reference check

• Fingerprinting check (MNJIS/CJIS)

Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3 business days from the start of employment; and successfully obtain/retain CJIS certification annually.

AN EQUAL OPPORTUNITY EMPLOYER

Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.

Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email [e-mail] . Please indicate what assistance is needed.