Working Title: Medicaid Payment Quality Assurance & Improvement Analyst
Job Class: Human Services Program Representative 2
Agency: Human Services Dept
Job ID : 90444
Location : St. Paul
Telework Eligible : Yes
Full/Part Time : Full-Time
Regular/Temporary : Unlimited
Who May Apply : Open to all qualified job seekers
Date Posted : 11/22/2025
Closing Date : 12/04/2025
Hiring Agency/Seniority Unit : Human Services Dept / MAPE DHS Central Office
Division/Unit : Health Care Administration / Medicaid Payment and Provider Services
Work Shift/Work Hours : Day Shift / 8:00am - 4:30pm
Days of Work : Monday - Friday
Travel Required : No
Salary Range: $32.40 - $47.76 / hourly; $67,651 - $99,722 / annually
Classified Status : Classified
Bargaining Unit/Union : 214 - MN Assoc of Professional Empl/MAPE
FLSA Status : Nonexempt
Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes
The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.
The work you'll do is more than just a job.
At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.
This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.
With comprehensive knowledge of combined Minnesota Health Care Programs (MHCP) business, systems, and policy perspectives this position monitors and maintains the integrity of Medicaid payments. The incumbent works to establish, coordinate, and maintain Medicaid payment procedures, processes, functions, and policies to assure the integrity of Medicaid payments in scope with overall MHCP program integrity.
This position identifies errors, gaps, trends, and opportunities for improvement. The desired outcomes include findings and prioritized recommendations and solutions for training opportunities within and outside of the business units, and updates and improvements to current policies and procedures. In addition, the incumbent will develop recommendations for enhancements or changes in legislation that enable the Medicaid Payments and Provider Services division (MPPS) to continue adding efficiencies to processes for both DHS and providers, help ensure greater consistency across both staff and system actions, as well as to ensure continuity of current system processes by being an integral part of future and ongoing modernization efforts as a subject matter expert (SME) for Medicaid claims payment.
Additional responsibilities include:
Reviews and evaluates MHCP claims payment and denial data to determine if the program is achieving its objectives by outlining report criteria and reviewing results in order to propose solutions, resolve problems discovered during the evaluation, and monitor outcomes. Documents problems and solutions, while continually analyzing and organizing data to ensure the integrity of program activity in relation to Medicaid payments.
Provide technical assistance to DHS staff and work with others on joint projects related to Medicaid payment activities and proper payment of claims.
Provides expert advice to stakeholders (MHCP program and service policy staff, MNIT, state and federal auditors, DHS OIG, Attorney General's Office, DHS FFOD, provider associations and other provider stakeholder groups) based on a comprehensive understanding of all procedural and technical aspects of program activities in relation to Medicaid payment activations and system coding, ensuring that changes they request are within limitations of the regulations and policies involved; assessing whether or not program parameters have been met; analyzing resource distribution to avoid duplication within or between programs; verifying the provided services are consistent with program plans; providing technical assistance, training and presentations on the Medicaid payment processes.
Determines compliance with MHCP programs so that management is kept up to date on program activities, and program needs are identified by monitoring and identifying issues and problems, such as systems logic applicable to meet State and Federal regulations.
Conducts detailed and comprehensive research of MMIS system change requests to proactively identify changes that will affect the integrity of the enrollment process so that program activities, program needs, and future program services are identified and addressed.
Implements MMIS system payment coding changes that affect financial reporting systems for state, federal, and other funding sources. Determines when it is necessary to notify other appropriate business areas, such as policy areas, provider training, communications, or enrollment, of MMIS coding changes and ensure the necessary communication is documented.
Develops recommendations for enhancements or changes in legislation that enable the unit to continue adding efficiencies to processes for both DHS and providers.
Minimum Qualifications
Three years professional experience working with Minnesota Health Care Programs payment policies and claims systems.
Experience must demonstrate:
Comprehensive understanding of and experience interpreting federal and state laws and regulations governing state and federal health care program payment policy requirements.
Proficiency with data analytics software
Preferred Qualifications
Medicaid Management Information System (MMIS) experience;
Experience and proficiency with Office Suite products such as Microsoft Excel, Word and Access;
Knowledge of health care financing and payment;
Experience with or knowledge of continuous improvement efforts;
Variety of experiences working effectively with others from different backgrounds and cultures.
Additional Requirements
To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.
REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.
AN EQUAL OPPORTUNITY EMPLOYER
Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.
Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email careers@state.mn.us . Please indicate what assistance is needed.
