State of Washington
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Financial Examiner 2 (FE2/MPOI)
at State of Washington
Job Status: Full Time
Job Reference #: 2515927
Overall Job Objective
Financial Examiner 2 (FE2/MPOI)
*Please Note: This position is open until filled. Application assessment will be ongoing and the hiring authority reserves the right to offer the position at any time during the recruitment process. It is to the applicant's advantage to apply as early as possible. First review of applicants will take place on July 29, 2019.*
This posting will be used to fill multiple positions.
This position performs professional work conducting regulatory analysis, examinations and audits of HCA-contracted Managed Care Entity (MCE) operations, expenditure and encounter reporting, program integrity activities, and MCE providers. MCEs include Managed Care Organizations, Behavioral Health Organizations, and Behavioral Health Administrative Service Organizations.
Some of what you will do:
- Interpret and apply the complexities of relevant federal and state regulations, and HCA policies and contract requirements.
- Ensure HCA/MCE contract language incorporates all required federal regulations and MCEs are compliant in meeting those regulations.
- Directly audit MCE encounter data to identify fraud, waste, and abuse issues with MCE providers, using proactive data mining activities, financial analysis and appropriate regulations.
- Assess liquidated damages to MCEs when fraud, waste or abuse with MCE providers is identified.
- Plan and conduct complex financial examinations of MCE encounter record submissions, utilizing risk-focused or statistical sampling methodologies.
- Plan and conduct field or desk reviews and risk-focused examinations of MCE operations, policies and procedures to ensure compliance with managed care contracts and federal regulations.
- Examine MCE program integrity/fraud, waste and abuse policies and procedures to ensure MCE has adequate controls to maintain compliance with federal regulations and contract requirements.
- Examine MCE audits of providers to determine if scope, findings, outcome and action taken is compliant with federal regulations and contract requirements.
- Conduct interviews of key MCE staff as needed to obtain additional information regarding MCE operations and controls.
- Take prompt corrective action and mandatory regulatory action when adverse findings are identified.
- Respond to disputes and appeals from MCE regarding corrective actions and audit adverse findings.
- Provide testimony in administrative hearings to defend financial examination corrective action plan adverse findings.
- Assist MCEs with referrals of potential fraudulent financial transactions to the Attorney General's Medicaid Fraud Control Division.
Here is what we are looking for (Required Qualifications):
A Bachelor's degree in finance, business administration, economics, accounting, health care policy, or closely related field.
Two years of professional experience in accounting and auditing; analyzing or examining regulated health care entities; Medicaid managed care regulations; or working for a regulated health care entity in an auditing, accounting, finance, or programmatic or operational managed care capacity.
- Additional relevant experience will substitute year-for-year for required education.
- Graduation from a specialized banking school gained through an accredited college or university as an Accredited Financial Examiner; OR certification as a Certified Financial Examiner from the Society of Financial Examiners; OR Washington State qualification as a Certified Public Accountant, may substitute for one year of relevant professional experience.
- A Master's degree in accounting, finance, economics, business administration, health care policy, or closely related field will substitute for one year of relevant professional experience.
- Strong data analytic skills with ability to recognize aberrant provider billing in claim and encounter data.
- High degree of initiative, self-starter, goal-oriented, and ability to motivate individuals to achieve targeted results.
- Excellent communications skills with ability to communicate effectively across multiple levels of the organization and with program customers and stakeholders.
- Strong planning and organizational skills.
- Strong Microsoft Office skills (Project, Word, Excel, PowerPoint, Outlook).
- Ability to work effectively in a potentially adversarial environment.
- Knowledge of relevant complex federal and state regulations concerning Medicaid, Program Integrity and Managed Care.
- Ability to apply knowledge and logic of regulations, and HCA policies and contract requirements, in evaluation of managed care encounter data.
- Understand the importance of examining financial expenditures.
- Knowledge of medical coding.
- Knowledge of program integrity principles.
- Knowledge of current and developing trends in medical healthcare delivery systems and billing.
- Knowledge of Health Insurance Portability and Accountability Act and Personal Health Information privacy rules, regulations, and policies.
Details of the In-Training Plan: (if needed)
At the discretion of the Appointing Authority, the Financial Examiner 2 may be filled as an in-training plan beginning at the Financial Examiner 1 level for a minimum of six (6) months. The in-training period may be extended, not to exceed 12 months.
Upon successful completion of the in-training period, the incumbent will advance to the goal class as a Financial Examiner 2 and serve a six (6) month review period. The FE2 review period may be extended, not to exceed 12 months.
If the position is filled as an in-training plan, the incumbent must successfully complete the in-training plan and the FE2 review period to obtain permanent status as a Financial Examiner 2. The in-training period and the goal class review period will run consecutively.
Financial Examiner 1 salary range: $3,198.00 - $4,161.00 monthly.
Financial Examiner 2 salary range: $4,953.00 - $6,496.00 monthly.
About the HCA:
The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
How to Apply:
Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position you will need to complete your profile and attach:
- A cover letter that specifically addresses how you meet the qualifications for this position.
- Current resume
- Three professional references
Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1761 or email Dennis.Lienemann@hca.wa.gov.
*Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position. *