Medicaid Surveillance Administrator

The incumbent in this position is responsible for managing provider audits and data analysis in order to identify and recover improper Medicaid payments. Duties include: serving as the liaison with the Medicaid Fraud Control Unit in the Attorney General’s office and the Managed Care Organizations, overseeing staff that uses predictive analysis and algorithms to identify aberrant providers and documenting and presenting evidence during hearings and appeals in court.

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

• Supervises the conduct of complex medical utilization and financial audits of providers and recipients for the State's Medicaid Program.
   
• Plans, advises, supervises, formulates work plans, assesses and evaluates methods and productivity for the unit.
   
• Supervises and monitors the "Restricted Recipient" Program by developing policies, standards and methods for identifying abusers of Medicaid services and ensuring corrective action is taken to control utilization by recipients.
   
• Supervises the maintenance of accounting records for recovery of overpayments for Medicaid Program statewide.
   
• Writes/monitors/negotiates contractual agreements. Collects, analyzes, reviews, and evaluates information provided by contracted services, audit firms and professional review organizations in order to assess compliance with quality care, financial regulations and Medicaid criteria.
   
• Develops, implements and supervises computerized systems for various components of Medicaid Program. Assesses current operations and regulation requirements for enhanced computerization.
   
• Supervises the investigation of and responses to complaints from providers, clients, etc.

JOB REQUIREMENTS for Medicaid Surveillance Administrator
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

1. Three years experience in health care reimbursement which includes reviewing and categorizing claims for proper billing, analyzing cost reports, examining cost containment, and interpreting and analyzing laws, rules, regulations, policies, procedures and standards affecting reimbursement and recovery.
2. Three years experience in making recommendations for continuation or changes to operations, programs, services, policies or procedures based on findings.
3. Three yeas experience in conducting studies such as evaluating operations, programs, services, policies and procedures to determine efficiency, effectiveness, whether goals and objectives are met and compliance with laws, rules, regulations, polices and procedures.
4. Six months experience in conducting investigations which includes conducting interviews to obtain confidential information, gathering evidence and documenting findings.
5. Six months experience in narrative report writing.
6. Knowledge of descriptive statistics such as the mean, median, mode or standard deviation.
7. Knowledge of managing information systems.
8. Knowledge of staff supervision of two or more employees which includes to plan, assign, review, discipline, recommend hire, promotion, termination and administer performance plans and reviews.

To learn more about the comprehensive benefit package please visit our website at http://ben.omb.delaware.gov/

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at www.delawarestatejobs.com.

Accommodations are available for applicants with disabilities in all phases of the application and employment process.  To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance.  The State of Delaware – An Equal Opportunity and Affirmative Action Employer.