Compliance Specialist 2 (07026,08041)

State of Montana
Helena, MT
Category Healthcare
Job Description
The Compliance Specialist 2 is responsible for identifying and investigating potential fraud, waste, and abuse within Montana Medicaid and Healthy Montana Kids (HMK) programs. Key duties include analyzing medical claims data, evaluating provider billing practices, and ensuring compliance with applicable state and federal regulations.

Requirements

  • Knowledge of Medicaid rules, medical claims processing, medical terminology and coding principles and practices.
  • Knowledge of reviewing, investigation, and research.
  • Knowledge of Health Information Portability and Accountability Act (HIPPA) compliance.
  • Ability to provide presentations to small groups.
  • Ability to perform math calculations.
  • Strong analytical and critical thinking skills.

Benefits

  • Healthcare coverage
  • Retirement plans
  • Paid vacation
  • Sick leave
  • Holidays
  • Work/life balance
  • Eligibility to participate in the Public Service Loan Forgiveness (PSLF) program
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