Program Integrity Audit and Investigation Analyst

General Description

Responsible for completing Audit and Investigation functions to support the successful delivery of Program Integrity (PI) goals and initiatives to minimize fraud, waste, and abuse in the State Medicaid system. To include: reviewing utilization for the Wyoming Medicaid Program, imposing appropriate adverse actions against providers, identifying compliance issues, and coordinating with law enforcement partners to ensure appropriate outcomes.

Position remains open until filled.

• Comprehensive health, dental, and vision insurance
• Paid vacation, sick leave, FMLA, and holidays
• Retirement - Pension and 457B plans that help you build a secure future
• Flexible schedules and work-life balance options
• Meaningful work that makes a difference for Wyoming communities

• Plan and conduct independent audits and investigations of Wyoming Medicaid State Plan and Waiver providers utilizing appropriate data analysis resources and tools. Review complex audit and investigation documentation, perform audit and investigation duties, and make remediation and corrective action plans based on audit or investigation findings. Make independent recommendations for the initiation of over payment recovery actions based on audit or investigative findings.
  
  Collaborate with law enforcement and Attorney General staff to testify on findings at contested case hearings and civil or criminal legal proceedings. Make recommendations and identify areas requiring further investigation to the Audits and Investigations Supervisor.
• Plan and conduct independent audits and investigations of Wyoming Medicaid State Plan and Waiver providers utilizing appropriate data analysis resources and tools. Review complex audit and investigation documentation, perform audit and investigation duties, and make remediation and corrective action plans based on audit or investigation findings. Make independent recommendations for the initiation of over payment recovery actions based on audit or investigative findings.
  
  Collaborate with law enforcement and Attorney General staff to testify on findings at contested case hearings and civil or criminal legal proceedings. Make recommendations and identify areas requiring further investigation to the Audits and Investigations Supervisor.
• Coordinate efforts and act as the primary point of contact for the Unified Program Integrity Contractor (UPIC). Coordinate referrals to the Unified Program Integrity Contractor (UPIC) and act as the primary point of contact for the federal UPIC, attending meetings, reporting on the ongoing status of referrals made, and coordinating the fulfillment of documentation requests. Update case file documentation to the PI case management system.
  
  Monitor ongoing status and outcome after referral.
• Oversee the monitoring of provider post-audit compliance, as outlined in the audit findings and corrective action plan. Set protocols and oversee implementation of provider self-audits and self-reporting. Draft procedure and policy related to the education of providers, notification of requirements, timelines, and findings. Facilitate and monitor the development, implementation, and execution of provider quality improvement plans. Direct validation of findings and written reports.
  
  Communicate recommendations to programs and management.

Minimum:
Bachelor's Degree (typically in Records or Data Management).

• 0-3 years of progressive work experience in (typically in Records and Data Management) with acquired knowledge at the level of a Records & Data Management Specialist II.
• OR 4-6 years of progressive work experience in (typically in Records and Data Management) with acquired knowledge at the level of a Records & Data Management Specialist II.

None.

• This position takes place in an average work environment.

• FLSA:
  Exempt
• The Wyoming Department of Health is an E-Verify Employer.

• to view the State of Wyoming Total Compensation Calculator.
• to view the State of Wyoming Classification and Pay Structure.

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The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Working for the State of Wyoming means more than a job — it’s a stable, rewarding career that lets you make a difference while enjoying a great quality of life.