State of Washington

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Program Integrity Administrator

at State of Washington

Pay: $89352 to $125100/year
$89352 - $125100
Posted: 11/15/2019
Job Status: Full Time
Job Reference #: 2632652
Keywords:

Job Description

Overall Job Objective

Description


Program Integrity Administrator
WMS Band 3
$89,352 - $125,100 Annually
 
This position is relied upon to ensure that the Health Care Authority is in compliance with State and Federal directives in developing a high degree of integrity for the Medicaid program. If you pride yourself on expert leadership abilities, quality decision making, and a strategic project management approach to your work, this may be the opportunity for you!
 
Position Objective:
This position will be an agency executive on the Medicaid Director's leadership team. The scope of this position is Medicaid-wide and impacts over 1.8 million clients statewide and over 60,000 providers.  Decisions made by this position impact Medicaid Program Integrity operations and compliance with federal and state Medicaid rules, regulations and policies.  The Medicaid Program Integrity leader manages an annual budget of approximately $5 million dollars, with policy decisions affecting a total Agency budget of $20.5 billion dollars biennially.
 
Medicaid Program integrity has the responsibility of preventing, detecting, and identifying improper payments, and ensuring the HCA's compliance with state and federal directives.  DPI accomplishes this mission by:
 
  • Reviewing and auditing managed care plan contract deliverables for program integrity activities and encounters to ensure plans meet contract and federal requirements.
  • Reviewing and auditing Medicaid provider payments to ensure services are provided, documented and payments are accurate and truthful Educating providers, recommending program changes and system edits to prevent improper payments.
  • Referring potential fraud or quality issues to the appropriate entity.
 
Some of what you will do:
 
Executive level responsibility for:
 
  • Directing, managing and overseeing the division.
  • Providing strategic short and long term direction related to program integrity compliance with federal and state regulations, and managed care entity compliance and accountability.
  • Participating in managed care contract and policy writing, and service delivery programs that support delivery of health care benefits to 1.8 million clients.
  • Assuring optimum use of the agency's resources and enhancing the effectiveness of agency employees.
  • Maintaining the highest standards of personal, professional, and ethical conduct and supporting the state's goal for a diverse workforce.
 
Qualifications:


Required qualifications:
Master's degree in Health Policy, Health Administration, Business Administration, Finance, Public Health, Public Administration or other health related fields or equivalent experience. 
 
At least five years of management experience, including oversight and supervision of other managers and operations.
 
Demonstrated senior level management skills and abilities, including project management, strategic leadership and decision making, quality and system improvement, fiscal management, and management of personnel issues.
 
Demonstrated ability to work with multiple stakeholders, facilitate and convene divergent groups to achieve a common goal.
 
Demonstrated ability to adapt and lead staff through changes within agency.
 
Ability to maintain and model the highest level of integrity and work ethics.
 
Demonstrated working knowledge of Medicaid Program Integrity.
 
Desirable/Preferred Education, Experience or Certifications:
Desired Education:
 
  • Doctor of Jurisprudence is preferred.
Desired Experience:
Working in a regulatory environment for health care services 

ABOUT 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.
 
About Olympia and Washington State
Washington State offers a total work/life package of pay, benefits, flexibility, and workplace opportunities to help you get the most out of your career and out of life. Washington State is a great place to work, play, and be a part of a community, offering quality of life that is unsurpassed. From the high energy urban center of Seattle, one of the nation's top ranked cities, to the more relaxed pace of our rural communities, Washington's distinctive Northwest lifestyle blends a progressive, creative culture with a casual nature.
 
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, including a minimum of one past supervisor
If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes.
  
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 360.725.1180 or email Sanyu.Tushabe@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. *