Provider Eligibility and Compliance Specialist / Human Services Program Specialist 1

Minnesota Department of Human Services; Saint Paul (MN); Hybrid; USD 33,000 - 48,000; Full time

Benefits offered by this job

Health insurance

Paid leave

12 paid holidays

Pension plan

EAP

Job summary

Minnesota Department of Human Services is seeking a Provider Eligibility and Compliance Specialist in St. Paul, MN.

The role focuses on screening, enrolling, and maintaining provider records to ensure compliance with State and Federal requirements for MHCP providers. Responsibilities include evaluating eligibility, processing initial enrollments, and maintaining ongoing MHCP eligibility through screening, certification, and licensure updates.

Qualifications

• Resume must clearly describe experience with month/year for each job
• 2 years advanced administrative support or paraprofessional experience
• Associate degree with 1 year related experience or Bachelor’s degree
• Experience with Medicaid provider enrollment and eligibility criteria
• Experience with MPSE, MMIS or similar claims systems

Responsibilities

• Screen, enroll, and maintain provider records to meet state and federal requirements
• Analyze provider enrollment and eligibility for counties, providers, and groups
• Respond to inquiries and draft analyses related to PEC policies and activities
• Modify systems, policies, and procedures based on investigations and findings

Skills

Lay language translation

Customer service

Problem solving

MS Office

Diversity collaboration

Education

Associate degree

Bachelor’s degree

Tools

MMIS / MPSE

Job description

• Telework Eligible: Yes

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: Yes

This position is eligible for telework 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:

• 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.

About Human Services Dept

WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.

Working together to improve the state we love.

What do Minnesota's State employees have in common?

• A sense of purpose in their work
• Connection with their coworkers and communities
• Opportunities for personal and professional growth

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.

Your benefits may include:

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
  • Fertility care, including IVF
  • Diabetes care
  • Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care
• Resources that provide support and promote physical, emotional, social, and financial well-being

Support to help you reach your career goals:

• Training, classes, and professional development
• Tuition reimbursement
• Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)

Employee Assistance Program (EAP) for work/life support:

• A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
• Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
• Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care

Programs, resources and benefits eligibility varies

Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

EQUAL OPPORTUNITY EMPLOYERS

Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.

Applicants With Disabilities

Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email [e-mail] and let us know the support you need.