Working Title: Medicaid Program Integrity Review Specialist
Job Class: Human Services Program Specialist 1
Agency: Human Services Dept
Job ID : 999999999999999
Location : St. Paul
Telework Eligible : No
Full/Part Time : Full-Time
Regular/Temporary : Limited
Who May Apply : Open to all qualified job seekers
Date Posted : 05/19/2026
Closing Date : 05/26/2026
Hiring Agency/Seniority Unit : Human Services Dept / MAPE DHS Central Office
Division/Unit : DHS-Central Office / BH Administration
Work Shift/Work Hours : Day Shift / 8:00am to 4:30pm
Days of Work : Monday - Friday
Travel Required : No
Salary Range: $23.98 - $34.69 / hourly; $50,070 - $72,432 / annually
Classified Status : Unclassified
Bargaining Unit/Union : 214 - MN Assoc of Professional Empl/MAPE
End Date : 12/01/2027
FLSA Status : Nonexempt
Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : No
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 posting will be used to fill five (5) temporary positions with State Benefits
This position is eligible for telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) 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.
Flexible work hours may be permitted with supervisor approval.
We are hiring five (5) temporary Medicaid Program Integrity Review Specialists (18-month positions, with the possibility of extension). These roles are part of a new review team that will examine behavioral health services billed to Minnesota's Medicaid program.
In this role, you will review clinical records and claims to make sure services meet program requirements and that public funds are used appropriately. The services you'll review include Adult Rehabilitative Mental Health Services (ARMHS), Intensive Residential Treatment Services (IRTS), Peer Services, and Assertive Community Treatment (ACT).
You'll work closely with teammates, a supervisor, and DHS policy experts in a collaborative environment. This is meaningful work that helps protect the integrity of Minnesota's Medicaid program.
What You'll Do:
Your day-to-day responsibilities will include:
Review clinical documentation - including records submitted for prepayment review, focused claims review, and provider recertification - to verify that it is complete, accurate, and meets state and federal requirements.
Apply clinical knowledge and Medicaid policy guidelines to make preliminary determinations about whether services were medically appropriate, claims are supported by documentation, and providers meet recertification standards.
Collaborate with policy experts and program specialists to clarify requirements, work through complex cases, and ensure consistent application of review standards across the team.
Maintain accurate records of your review activities to support audits, provider communications, and program oversight.
Participate in ongoing training and quality improvement activities to stay current on behavioral health services, documentation standards, and review procedures.
Minimum Qualifications
Please make sure your resume clearly describes your experience in the areas listed below, including the start and end month/year for each position held.
One (1) year of high-level experience in a human services program that includes working with Medicaid providers along with meeting the required applicant work experience listed below **.
OR**
Three (3) years of advanced technical or paraprofessional practical experience in a human services program that includes working with Medicaid providers along with meeting the required applicant work experience listed below.
OR
Bachelor's degree or higher in human services, social work, or a closely related field and two (2) years of advanced technical or paraprofessional experience to a human services program that includes working with Medicaid providers along with meeting the required applicant work experience listed below.
Required applicant's experience must demonstrate:
Working understanding of behavioral health conditions and treatment approaches.
Experience understanding and applying Medicaid program rules and medical necessity concepts.
Practical knowledge of clinical documentation standards and behavioral health service delivery systems.
Familiarity with HIPAA, Minnesota data practices law, and confidentiality requirements for handling sensitive health information.
Experience with or awareness of program integrity review methods (such as prepayment review, focused claims review, or provider recertification review), audit processes, fraud prevention, and Medicaid program integrity standards.
A basic understanding of healthcare coding and billing as it applies to behavioral health services.
Proficiency using computers for data entry and electronic documentation systems.
Preferred Qualifications
Strong analytical and critical thinking skills - able to evaluate clinical documentation and identify issues.
Excellent attention to detail, especially when reviewing records for discrepancies or missing information.
Clear written communication skills for documenting findings in a professional, organized way.
Ability to manage multiple reviews at once and prioritize effectively.
Collaborative and interpersonal skills to work well with policy experts, providers, and team members from a variety of backgrounds and cultures.
Ability to research, interpret, and apply policy updates and clinical guidelines.
Experience with Medicaid claims platforms, electronic health record (EHR) systems, or reporting tools.
Additional Requirements
MinnesotaDepartmentofHumanServices(DHS)criminalbackgroundcheckwillbeconductedonallfinalists forthisposition.Finalistsmustpassthe DHS backgroundcheck.
Employee reference checks will be conducted on all finalists. This may include a review of documentation related to jobperformance.It alsoincludescontact withtheapplicant'sformer employer(s).
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.
