Business Operations Specialist

Description and Functions

Open Until Filled

GENERAL DESCRIPTION:

The Business Operations Analyst will serve as an integral part of the Program Integrity (PI) this position a successful candidate will support PI goals and initiatives to minimize fraud waste and abuse in Wyomings state Medicaid system. The Business Operations Analyst will be responsible for activities related to the Annual Single Statewide Audit of the Medicaid program and will assist in overpayment recovery activities. The Business Operations Analyst will receive and track provider payments and facilitate the delivery of documentation to relevant partners.

Working for the State of Wyoming offers more than a paycheck. Our total compensation package includes:

• Comprehensive health dental and vision insurance

• Paid vacation sick leave FMLA and holidays

• Public Service Loan Forgiveness (PSLF) eligibility

• Retirement - Pension and 457(b) plans that help you build a secure future

• Flexible schedules and work-life balance options

• Meaningful work that makes a difference for Wyoming communities

and MUCH MORE! Click here for detailed information or you can watch this short video to learn about our benefits package!

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Human Resources Contact:

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level.

• Manage the annual Single Statewide Audit (SSA) activities for the Medicaid program coordinating with DHCF staff medical record reviewers fiscal staff contractors providers and external auditors.
• Develop and maintain internal procedures to support audit compliance including document management claims submissions records requests and other Program Integrity audit activities.
• Compile organize track and submit required audit documentation provider information claims data certified mail receipts and provider responses within established deadlines.
• Manage provider outreach related to audit records requests including follow-up with non-responsive providers case creation and appropriate recovery actions.
• Coordinate with Utilization Management contractors on medical necessity reviews and compile review documentation for auditors and DHCF leadership.
• Gather and communicate audit findings to DHCF leadership and provide recommendations for process or program improvements when appropriate.
• Manage Program Integrity payment processing including provider payments overpayments credit balance recoveries account updates and the return of federal funds in accordance with applicable requirements.
• Coordinate with Benefits Management System contractors fiscal staff and other partners to ensure payments are accurately tracked documented and applied to provider accounts.
• Support payment plans provider payment suspensions and terminations settlement enforcement actions and Administrative Hearing preparation including documentation and deadline tracking.
• Maintain accurate financial information within the Fraud Waste and Abuse system and compile documentation supporting Program Integrity administrative and recovery actions.
• Develop and maintain fiscal reports covering payments recoveries credit balance aging write-offs fraud restitution global settlements and other financial activity while supporting compliance with federal funding requirements.
• Compile and submit required fiscal reporting including HealthStat data and the annual Medicaid Fraud Control Unit reconciliation report.

Qualifications

PREFERENCES:

Preference will be given to candidates with:

An Associates degree or higher in Accounting or a related field; experience in database creation and management; experience in financial management and payment tracking.

KNOWLEDGE:

• Knowledge of State and federal government functions procedures policies rules and laws.

• Knowledge of Medicaid functions procedures policies rules and laws.

• Knowledge of technology and systems in use by the department.

• Knowledge of audit and investigation processes.

• Knowledge of fraud and abuse detection methods and systems.

• Knowledge of State Personnel Rules.

• Knowledge of basic database creation and management.

• Knowledge of basic statistical compilation and analysis.

• Knowledge of operation of all current and commonly used office technology such as office and cell phones computers copy machines and faxes.

• Ability to apply this usage to the organization of work tasks.

• Skill in research and analysis of complex problems identification of options and solutions evaluation of results and decision-making.

• Skill in process procedure and policy development and implementation.

• Skill in interpreting and participating in fiscal reporting.

• Skill in public speaking and oral and written communication to varied audiences on complex and controversial issues.

• Ability to establish and maintain positive working relationships with internal and external individuals and groups.

• Ability to accept and be flexible with Federal State and Agency changes.

• Ability to balance multiple demands on time and resources.

• Ability to self-educate both formally and informally to remain current in areas of responsibility.

MINIMUM QUALIFICATIONS:

Education:

Bachelors Degree (typically in Human Services)

Experience:

0-2 years of progressive work experience (typically in Benefits and Eligibility) with acquired knowledge at the level of a Quality Assurance Specialist

OR

Education & ExperienceSubstitution:

3-5 years of progressive work experience (typically in Benefits and Eligibility) with acquired knowledge at the level of a Quality Assurance Specialist

Certificates Licenses Registrations:

None

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

• The employee may sit comfortably to perform the work; however there may be some walking standing bending carrying light items driving an automobile etc.

NOTES:

• FLSA: Non-Exempt
• The Wyoming Department of Health is an E-Verify employer.

Supplemental Information

Click here to view the State of Wyoming Total Compensation Calculator.

Click here to view the State of Wyoming Classification and Pay Structure.

URL: State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change please refer to the A & I HRD Website to ensure that you have the most recent version.

Required Experience:

IC