Business Operations Specialist

Open Until Filled

GENERAL DESCRIPTION

The Business Operations Analyst will serve as an integral part of the Program Integrity (PI) team. In this position, a successful candidate will support PI goals and initiatives to minimize fraud, waste, and abuse in Wyoming’s 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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Explore our Total Compensation Calculator: compensationcalculator.wyo.gov

Human Resources Contact: View email address on click.appcast.io

ESSENTIAL FUNCTIONS

• 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.

PREFERENCES

Preference will be given to candidates with:

An Associate's 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: Bachelor's 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

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.

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

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

URL:

The 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.