Government Programs Analyst

POSITION SUMMARY

The Government Programs Analyst is responsible for assisting the Director of Government Programs and Government Programs Administrator with Medicare and Medicaid markets with primary focus on fraud and abuse related reviews, audits, and special projects as needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Key Responsibilities

• Fraud and Abuse (Under the direction of Government Programs Director and/or Government Programs Administrator)
  1. Works with the Director of Government Programs, Government Programs Administrator, Data Analyst, Dental Director, and others as needed to identify unusual utilization patterns for potential candidates for audits. 
  2. Determines scope of Government Programs dentists' audits. Schedules audits and collects pertinent documentation and information from dentists/dental offices. Analyzes and interprets data to determine dentists' compliance with the Medicare/Medicaid Provider Manuals and other guidelines. Prepares timely, detailed, and accurate workpapers, exhibits and reports and communicates findings internally and to requesting entity. Develops corrective actions and follows through to resolutions.
  3. Analyzes effectiveness and efficiency of the Government Programs network dentists' utilization monitoring and audits and proposes recommendations for enhancements.
  4. Raises awareness of fraud issues and serves as an expert for fraud and abuse matters.
• Assists the Director of Government Programs and/or Government Programs Administrator with projects (i.e., reporting, analyses, external audits, etc.) related to Medicare and Medicaid business.

Other Duties and Responsibilities

• Prioritizes and organizes own work to meet both formal and informal deadlines with minimal supervision.
• May be required to serve as back-up on specific tasks to the Director of Government Programs and/or Government Programs Administrator.
• Other miscellaneous duties and responsibilities as assigned by the Director of Government Programs.

MINIMUM QUALIFICATIONS AND EXPERIENCE

Education

Bachelors degree in business administration or health related field, or an equivalent combination of education, training or work experience.

Experience 

• Two or more years of audit and/or fraud investigation experience. 
• Experience in reviewing and analyzing data.
• Medicaid and/or Medicare experience preferred.
• Dental claims processing experience preferred.

Skills and Knowledge

• Well-developed understanding of audit techniques and practices.
• Well-developed understanding of data analysis techniques and practices.
• Ability to analyze complex topics and issues and recommend alternatives and solutions.
• Ability to communicate clearly and fluently in writing and orally with participating dentists and HDS management on sensitive matters.
• Ability to handle multiple tasks with strong attention to detail and adapt to changing priorities. 
• Ability to handle confidential and sensitive issues and materials.
• Ability to work well under pressure and meet deadlines.
• Technical knowledge to understand computer applications for data analysis and problem-solving.
• Valid Hawaii driver’s license and personal transportation vehicle needed.

Note: The above information in this description has been designed to indicate the general nature and level of work performed by an employee in this classification.  It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job.  Hawaii Dental Service has the right to add to, revise, or delete information in this description.  Reasonable accommodation will be made to enable qualified individuals with disabilities to perform the essential functions of this position.