Medicaid Program Integrity Reporting & Coding Oversight Officer
The Iowa Department of Health and Human Services (HHS), Iowa Medicaid Division, is seeking a Program Integrity Reporting & Coding Oversight Officer.
Medicaid is a state-federal funded program that is administered by the Iowa Department of Health and Human Services and is the second largest insurance program in the State of Iowa. Be part of an organization that is continually working to modernize and innovate solutions to improve the quality of life and health outcomes for the state’s Medicaid members.
The Program Integrity Reporting & Coding Oversight Officer, under the supervision of the Program Integrity & Compliance Bureau Chief, is responsible to ensure the integrity of the Iowa Medicaid program, as it applies to payments to providers. As the payment integrity subject matter expert (SME), this position analyzes and understands provider billings, manages risk of overpayment, and anticipates areas of program cost avoidance. This position is responsible for planning, implementation, and ongoing coordination of federal and State Medicaid
program integrity-related requirements in accordance with the Center for Program Integrity (CPI), the Centers for Medicare and Medicaid Services (CMS), and state law.
As the Division lead on the application of national coding requirements, this position will coordinate and lead the work of the agency’s national Correct Coding Initiative (CCI) vendors by evaluating the Agency's use of appropriate system edits to prevent improper payment of claims; monitoring coding quality and productivity metrics; and implementing improvement initiatives. Responsible to provide oversight of coding policies, procedures, and guidelines in accordance with relevant coding standards (i.e. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS).
This key position will direct, guide, and evaluate the activities of the Program Integrity Unit Managed Care Plans Oversight (MCPO) Vendor in collaboration with other Division staff. In addition, this position will provide oversight of the Medicaid Managed Care Plans (MCPs) Program Integrity activities. This includes monitoring MCP reporting, developing monitoring standards, and reviewing MCP reports to identity trends, gaps and potential program vulnerabilities.
The Department is seeking candidates with experience in reviewing and processing public or private health care insurance claims. Those who possess a thorough understanding of medical insurance billing and coding practices and are proficient in reviewing and conducting claims research and analysis to resolve claim discrepancies to ensure billing accuracy and compliance within health insurance policy and industry standards are encouraged to apply.
Successful candidates will:
- Comprehend and interpret federal requirements and how those apply to state compliance.
- Prioritize work assignments to effectively meet deadlines.
- Understand capitation rate setting, MMIS systems and HIPAA coding.
- Analyze a variety of information to identify areas of non-compliance.
- Identify complex problems, evaluate areas of risk then develop and evaluate options for compliance.
- Communicate effectively to inform and foster productive relationships. .
Special Requirements:
Preference given to candidates with: Bachelor's degree in health care field; CMS ICD-10 and DRG coding experience; Coding Certification, such as Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC)
About Iowa HHS:
The Iowa Department of Health and Human Services (Iowa HHS) makes a positive difference in the lives of Iowans. Our mission is to help achieve healthy, safe, stable, and self-sufficient lives through the programs and services we provide. We have a great total compensation package for full-time employees, including:
- Iowa Public Employees' Retirement System (IPERS)
- Retirement Investors Club (RIC) (Employer Sponsored Retirement Plan)
- Health, Dental and Vision Insurance
- Vacation Leave
- Sick Leave
- Paid Holidays (9 days/year)
- Flexible Spending Accounts
- Life Insurance
- Long-Term Disability Insurance
Our agency uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify.
Qualifications
Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification:
1) Graduation from an accredited four-year college or university with a degree in any field, and experience equal to four years of full-time professional-level work in program administration, program development, program operations, or management.
2) A total of eight years of education and/or full-time experience (as described in number one), where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience.
3) All of the following (a, b, and c):
a. Two years of full-time professional-level work experience in program administration, program development, program operations, or management; and
b. A total of four years of education and full-time experience (as described in part a), where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience; and
c. A total of two years of graduate-level education and full-time experience (as described in part a), where twenty-four semester hours of accredited graduate college or university course work in a public-service-related area (e.g., public or business administration, social work, public health, law, education, engineering) equals one year of full-time experience. Graduation from the Iowa Certified Public Manager Program is also equivalent to one year of full-time experience or education.
4) Current, continuous experience in the state executive branch that includes twelve months of full-time work as an Executive Officer 1 or comparable specific management-level position.
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