Program Integrity Coordinator

Program Integrity Coordinator (HCA/MAD #10118671) Our Vision Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system. Our Mission We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services. Our Goals Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce. Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives. Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information. Build the best team in state government by supporting employees continuous growth and wellness. Why does the job exist? The Program Integrity Coordinator will: Provide operational and coordination support for Program Integrity activities impacted by HR1 implementation; Support the execution, tracking, and documentation of integrity-related activities to help ensure compliance and accountability; Support oversight efforts and maintain accurate records related to program integrity functions. How does it get done? The Program Integrity Coordinator is responsible for: Supporting Program Integrity activities by assisting with coordination, documentation, tracking, and data collection; Supporting preparation of reports, tracking action items, maintaining records, and assisting with communication across eligibility, payments, policy, and systems teams; Ensuring integrity activities are implemented consistently and supporting monitoring and reporting needs; Focusing on duties in the Fee for Service Unit including: Reviewing and processing suspended claims; Maintaining claim notes updated for tracking and auditing purposes; Identifying provider billing issues and referring to FFS Quality for provider training opportunities aligning with HR1; Reviewing and analysis of reports; Conducting research and providing analysis; Creating and updating internal guides and workflows, including policy review, guidance and revisions; Participating in meetings bureau and division wide and any other assigned duties. Who are the customers? Internal stakeholders across Health Care Authority (HCA) and Medical Assistance Division (MAD), including program integrity staff, eligibility and payments teams, policy partners, and leadership involved in oversight activities. Ideal Candidate The Ideal Candidate has experience: Supporting program integrity, compliance, or oversight activities in public-sector programs; Coordinating meetings, tracking action items, and maintaining documentation; Assisting with data collection and monitoring activities; Preparing summaries and basic reports for review; Communicating clearly with internal stakeholders; Working within regulated or compliance-driven environments; Managing assigned tasks in support of oversight and accountability goals; Reviewing reports and claims; Writing, reviewing and implementing processes and policies. Associate degree in Business Administration, Healthcare Administration, Statistics, Finance, or a related field and two (2) years of experience with a public assistance program, medical, healthcare, educational, or state facility working with policies and procedures, conducting analysis/research, providing or requesting information from the general public, working with communities, working on health or social service related matters, social work/case management, behavioral health, and/or health care. Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling four (4) years may substitute for the required education and experience. Employment Requirements Must possess and maintain a valid driver's license. Must obtain a Defensive driving certification. Working Conditions Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT), extensive personal computer and phone usage with extended periods of sitting. Supplemental Information Do you know what Total Compensation is? Click here For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement. Bargaining Unit Position This position is covered by a collective bargaining agreement and all terms/conditions of that agreement apply and must be adhered to. #J-18808-Ljbffr