Health Care Compliance Analyst

Title:Health Care Compliance Analyst

State Role Title:Health Care Compliance Spec II

Hiring Range: $57,299 - $94,462

Pay Band: 5

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as a Health Care Compliance Analyst. The selected competitive candidate will provide exceptional delivery of services to the agency's Program Integrity Division.
Job responsibilities will include, but are not limited to:
This position will provide managed care oversight in the review of program integrity strategies and provide technical assistance as needed.
Perform compliance reviews of Medicaid services to determine compliance with contracts/agreements in addition to Federal and State regulations and policy.
Process referrals and complaints received, to include processing referrals to be sent to the Medicaid Fraud Control Unit (MFCU) at the Office of the Attorney General (OAG).
This position will conduct compliance reviews on provider types enrolled in the Virginia Medicaid Program, as well monitor compliance with auditing contracts to include Managed Care Organizations using Federal and State regulations, DMAS policy and contract compliance.
Conduct compliance reviews of Managed Care Organizations (MCOs) participating in the Virginia Medicaid Program.
Conduct quality assurance reviews of audits performed by MCOs participating in the Virginia Medicaid Program. Other duties as assigned by management.
Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org
The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality Health Care coverage.
DMAS wants talented individuals who can align their experience with the mission of the agency and its core values - service, collaboration, trust, problem solving and adaptability.
At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:
Considerable knowledge of Managed Care Organizations, principles and technical methods of medical auditing, utilization review/utilization management for all Virginia Medicaid programs and contract compliance.
Knowledge/experience to analyze data and resolve problems; research and identify changes in program requirements and policies; to interpret State and Federal regulations and contracts.
Knowledge/experience to organize and prioritize work assignments; prepare comprehensive reports; develop and conduct training.
Knowledge/experience to analyze computer generated reports and medical records to determine appropriateness of billing and medical necessity for and appropriateness of treatment and to analyze audit findings.
Knowledge/experience in the use of personal computers.
Knowledge/Experience interpretation and application of federal, state laws/regulations.
Experience in meeting deadlines.
Experience with internal/external stakeholder.

Additional Considerations

There are no additional considerations at this time.

Special Instructions

You will be provided a confirmation of receipt when your application and/or resume is submitted successfully. Please refer to "Your Application" in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the EVerify Program.
The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth's Department of Human Resource Management Policy 1.61 Teleworking.
This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.
If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.
Applications and/or resumes should include relevant work history which indicates your qualifications for this position.
The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.
In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155
The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition Team

Phone:

Email: askhcdtalentacq@dmas.virginia.gov

In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.