Job Description

Overview
Provide investigative, analytical, and consultative work at a professional level for Department of Vermont Health Access (DVHA) involving health insurance and health care delivery systems. DVHA's Special Investigations Unit is seeking a Program and Operations Auditor to join their team to prevent fraud, waste, and abuse and help Vermont Medicaid recipients receive all the care and resources they need.
Work in a supportive work environment with a Monday-Friday schedule, eleven paid state holidays, in addition to a robust benefits package.
The Program and Operations Auditor Position has the following responsibilities:

• Work in program integrity, quality control, and utilization review.
• Continuing assessment (review) of health care systems and their design, development, implementation, and on-going operations.
• Identification of unusual beneficiary and provider utilization patterns including procedural deficiencies in the reporting and claiming of reimbursement for services in these programs.
• Extensive knowledge and interpretation of medical claims billing policies and practices and claims processing is essential.
• Knowledge of revenue cycle, claims processing
• Medical Coding (preferred)

Duties are performed under the direction of the Special Investigations Unit Manager but involve extensive interaction with:

• Medical service providers.
• Division Directors.
• Agency of Human Services program managers.
• State program managers.
• Federal officials.

Mission:
The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.
Diversity, Equity, and Inclusion:
As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.
Our State:
Vermont is a "small but mighty" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.
Who May Apply
This position, DVHA Programs and Operations Auditor (Job Requisition #54404), is open to all State employees and external applicants.
If you would like more information about this position, please contact Sawyer Joecks at .
Resumes will not be accepted via e-mail. You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.
AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.
Environmental Factors
Duties are performed primarily in a standard office setting, but with frequent travel to outlying medical practice sites for which private means of transportation must be available. Pressure of deadlines and investigative needs may require some work outside of normal office hours.
Minimum Qualifications
Graduate degree in public administration, finance, accounting, health insurance, or health care AND one (1) year or more at a professional level in a health/health insurance/human services program or organization.
OR
Bachelor's degree AND three (3) years or more at a professional level in a health/health insurance/human services program or organization.
OR
Associate's degree AND five (5) years or more at a professional level in a health/health insurance/human services program or organization.
OR
High School diploma or equivalent AND seven (7) years or more at a professional level in a health/health insurance/human services program or organization.
Special Requirements
Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.
Total Compensation
As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 11 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

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Equal Opportunity Employer
The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State's employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.

Skills Required