DVHA Programs and Operations Auditor

at State of Vermont in Waterbury, Vermont, United States

Job Description

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.

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.