Departmental Specialist 13 - HS ENROLLMENT AND PAYMENT INTEGRITY SECTION

About the Department

This position serves as the MI Coordinated Health Enrollment, Systems, and Payment (MICH ESP) Compliance Specialist within the Enrollment and Payment Integrity Section. The specialist is responsible for oversight and compliance activities related to Electronic Visit Verification (EVV) adoption and compliance monitoring, Exclusively Aligned Enrollment (EAE) compliance, and State Directed Payments (SDP) for Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs). The role is responsible for policy research, regulatory interpretation, and program analysis that inform operational decisions, compliance monitoring, and program integrity functions within the section. 

The position is a subject matter expert in federal and state statutes and regulations governing integrated care models, D SNPs, Medicare Advantage, and Medicaid managed care. This position is responsible for reviewing statutory and regulatory requirements across integrated care models, D SNPs, Medicare Advantage, and Medicaid managed care and applying those rules to determine whether program operations are compliant. The specialist analyzes Medicaid Data Warehouse information, claims, encounter reporting, and payment adjudication outcomes to identify misalignments, flag non compliant activity, and initiate corrective actions. These responsibilities directly support accurate MICH enrollment processing and proper administration of State Directed Payments by ensuring issues are detected, evaluated, and resolved according to policy.

Position Description

Job Specification

To be considered for this position you must:

• apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
• relevant experience and/or education referred to in supplemental questions must be documented in resume, transcript and/or application to allow for accurate screening.
• attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
• attach a cover letter.
• if applicable, attach a copy of an official transcript(s).  We accept scanned copies of official transcripts.  We do not accept web-based, internet, or copies of unofficial transcripts.  Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature.

Failure to complete any of the above items may result in your application not being considered.  See instructions for attaching files here:  Instructions

Position Duties

Education
Possession of a bachelor’s degree in any major

Experience

Departmental Specialist 13
Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level.

Other Qualifications

The physical location of this position is 400 S. Pine Street, with remote options available.  Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered.

 Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.  

Employees will be provided computers to perform state work.  Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:

• A secure work location that allows privacy and prevents distractions.
• A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
• Suitable lighting, furniture, and utilities.

The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises.

YOUR APPLICATION FOR ANY POSITION DOES NOT GUARANTEE YOU WILL BE CONTACTED BY THE DEPARTMENT/AGENCY FOR FURTHER CONSIDERATION.  ONLY THOSE APPLICANTS INTERVIEWED WILL BE NOTIFIED OF THE RESULTS.

The department reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received.

If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required.

For information about this specific position, please email [email protected]. Please reference the job posting number in subject line. 

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