Job Description

Work for Indiana

Begin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and measurable impact on the lives of Hoosiers across Indiana.

About the Family & Social Services Administration:

The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services Administration, which receives around 18 percent of the state's budget to ensure vital health care coverage to approximately 1 in 4 Hoosiers. OMPP strives to build programs and processes that enable Hoosiers to live in fully engaged communities and reach their greatest emotional, mental, and physical well-being. Our mission is to support individual and community well-being with effective and efficient programs, remarkable collaborations, measurable impact on individuals and communities, and an energized staff that is fully engaged with this mission.

Role Overview :

This role, Program Integrity Managed Care Coordinator, is responsible for the oversight and managing the work of the the State's Managed Care Entities (MCE) Special Investigation Units (SIU) to ensure that fraud, waste, and abuse in the Indiana Medicaid system is addressed. You will serve as coordinator for the Program Integrity Provider Review Committee (PIPRC) which reviews referrals to determine if a Credible Allegation of Fraud (CAF) has been found. Your role also serve as the Program Integrity team’s primary point of contact for its Fraud Abuse Detection System (FADS) contractor for MCE SIU related matters.
The ideal candidate will have a bachelor’s degree in healthcare administration, informatics, public health, public administration or related plus five years of experience. Graduate degree or previous HMO experience preferred. Credential in health information/coding or auditing (e.g. RHIA, RHIT, CCS, CCS-P, CPC, or CFE) and experience with utilization review, coding, or retrospective medical claim auditing is desired.

Salary Statement :

The salary for this position traditionally starts at $75,010.00 but may be commensurate with education or work experience.

A Day in the Life:

The essential functions of this role are as follows:

• Plan, organize, direct, monitor, and participate in ongoing comprehensive development and implementation of specialized programs and development within the agency.
• Determine, analyze, identify and implement long-range objectives and specifying the strategies, KPIs, and actions to achieve them.
• Analyze operations to evaluate performance of the specific program or its staff in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy change.
• Interpret and explain in-depth and complex policies, rules, regulations, or laws to organizations, government or corporate officials, or individuals.
• Develop and implement corrective action plans to solve organizational or departmental problems.
• Prepare and present reports for approval, including those for funding or implementation of services to executive leadership.
• Develop and oversee program financial or budget activities to fund operations, maximize investments, or increase efficiency.
• Develop and monitor program requirements to ensure it meets federal and state policies and grants compliance.
• Develop and supervise training of employees and consultants on program requirements and usage.
• Develop, coordinator, and deliver communication plans and communications.
• Preside over, or serve on, boards of directors, management committees, or other governing boards.
• Recruit, select, onboard, and train employees to ensure role responsibilities and expectations are clearly understood while providing opportunities to continue professional development.
• Set expectations, measure progress, provide ongoing feedback, and evaluate the performance of employees. Ensure work adheres to quality standards, deadlines, and proper procedures.
• Some essential functions of this position may be performed onsite at the agency’s worksite or other assigned worksites while some essential functions of this position may be eligible for work from home authorization in accordance with policy. Remote work authorization is not automatic and is dependent upon operational needs and agency approval.

The job profile is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

This position is exempt from overtime compensation for additional work hours which may be required to complete essential functions or other assigned work. Exempt employees may work more than 75 hours in a pay period without additional compensation and must report a minimum of 75 hours per pay period of work hours and/or paid leave taken to receive their base biweekly salary.

What You'll Need for Success:

The ideal candidate in this role should minimally have either

• a Master’s Degree and 7+ years of experience,
• or a Bachelor’s Degree and 9+ years of experience, or
• an Associate’s Degree and 11+ years of experience, or
• at least 13+ years of experience applying the below, outlined knowledge, skills, and abilities in a similar role.

You must meet the following requirements to be considered for employment:

• Extensive knowledge of the principles, practices, and techniques of a broad area of training and education, including texts and materials developed in the field.
• Thorough knowledge of the agency or institution’s functions, operations, and purpose.
• Considerable knowledge of experiential learning techniques.
• Practical knowledge of laws, rules, and regulations governing mandated training within the agency.
• Ability to develop, monitor and evaluate broad training programs.
• Ability to plan and conduct seminars, workshops, and training sessions.
• Ability to assemble training materials, including writing comprehensive manuals and assembling texts, films, slides, and characters.
• Ability to establish effective and cooperative working relationships with trainees, other instructors, and the entire agency staff.
• Effective communication skills.
• Ability to keep current on new trends, philosophies, and available materials regarding adult education.
• Ability to delegate work, set clear direction, and manage workflow.
• Ability to effectively give feedback, provide guidance or corrective action, coach, and develop employee skill sets.
• Able to perform essential functions with or without reasonable accommodation.

Supervisory Responsibilities/Direct Reports:

This role may provide direct supervision for one or more staff members.

Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefit package for full-time employees which includes:

• Three (3) medical plan options (including RX coverage) as well as vision and dental plans
• Wellness Rewards Program: Complete wellness activities to earn gift card rewards
• Health savings account, which includes bi-weekly state contribution
• Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities
• Deferred compensation 457B account (similar to 401k plan) with employer match
• Two (2) fully-funded pension plan options
• A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:
  • 150 hours of paid New Parent Leave and up to eight weeks of paid Childbirth Recovery Leave for eligible mothers
  • Up to 15 hours of paid community service leave
• Combined 180 hours of paid vacation, personal, and sick leave time off
• 12 paid holidays, 14 on election years
• Education Reimbursement Program
• Group life insurance
• Referral Bonus program
• Employee assistance program that allows for covered behavioral health visits
• Qualified employer for the Public Service Loan Forgiveness Program
• Free Parking for most positions
• Free LinkedIn Learning access

Equal Employment Opportunity:

The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process as well as perform the essential functions of a role. If you require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at jobs@spd.IN.gov.

Job Tags

Holiday work, Full time, For contractors, Traineeship, Work experience placement, Remote job, Work from home, Flexible hours,

Similar Jobs