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 Medical Record Reviewer, conducts comprehensive reviews of medical records and related documentation to determine the appropriateness, medical necessities, and accuracy of services billed to the Medicaid program. This role plays a key role in supporting audits, investigations, and program integrity activities to detect, prevent, and recover based upon fraud, waste, and abuse within the Medicaid system.
The ideal candidate will have an Associate’s or Bachelor’s degree in Nursing or related healthcare field. An active Registered Nurse (RN) license in good standing preferred; LPN or other clinical credentials may be considered. They will have a minimum of three years of experience in clinical care, utilization review, medical auditing, compliance, or similar field. Knowledge of Medicaid or other healthcare reimbursement systems, coding (ICD, CPT, HCPCS), and documentation standards are strongly preferred. Certification in medical auditing or coding (e.g., CPC, CFE, CPMA, CFE, CQA) is preferred. 

 
Salary Statement : 

The salary for this position traditionally starts at $67,314.00 but may be commensurate with education or work experience.

A Day in the Life:

The essential functions of this role are as follows:

• Establish, monitor, 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.

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 5+ years of experience, or
• a Bachelor’s Degree and 7+ years of experience, or
• an Associate’s Degree and 9+ years of experience, or
• at least 11+ 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:

• Mastery knowledge in program subject matter obtained through experience and/or education. 
• Broad knowledge of provider agencies and their programs and services.
• Broad knowledge of all source materials and references including federal and state laws governing the programs.
• Ability to adapt new statues and guidelines to create and implement new principles and policies and discern any far-reaching implications.
• Ability to present and represent the agency to both internal and external customers, the public, government officials, and other stakeholders.
• Analyzing information and evaluating results to choose the best solution and solve problems.
• Ability to work effectively with a wide variety of stakeholders.
• Ability to analyze and prepare monthly finance and accounting reports to maintain program budget and grants.
• Ability to delegate work, set clear direction, and manage workflow.
• Ability to effectively give feedback, provide guidance or corrective action, coach, and develop employee skillsets.
• Able to perform essential functions with or without reasonable accommodation.

Supervisory Responsibilities/Direct Reports:

This role may serve as a team lead for an assigned work group.

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
• Deferred compensation 457(b) account (similar to 401(k) 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 .

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