Lead Program Eligibility Auditor - Human Services Program Representative 2

Job summary

Conduct eligibility and quality assurance reviews, including medical record and claims error reviews for the Payment Error Rate Measure. Serve as a lead resource and subject matter expert for auditors, resolve disagreements, escalate issues, and develop performance dashboards, orientation materials, and reviewer guidance.

Job details

Working Title: Lead Program Eligibility Auditor Job Class: Human Services Program Representative 2 Agency: Human Services Dept Job ID: 97283 Location: St. Paul Telework Eligible: Yes Full/Part Time: Full-Time Regular/Temporary: Unlimited Who May Apply: Open to all qualified job seekers Date Posted: 09/25/2026 Closing Date: 10/08/2026 Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office Division/Unit: DHS-Central Office / Program Compliance & Audits HC Work Shift/Work Hours: Day Shift, 8:00am - 4:30pm Days of Work: Monday - Friday Travel Required: No Salary Range: $32.97 - $48.60 / hourly; $68,841 - $101,476 / annually Classified Status: Classified Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE FLSA Status: Nonexempt Designated in Connect 700 Program for Applicants with Disabilities: Yes The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify. The work you'll do is more than just a job. At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities. This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.*** The Lead Program Eligibility Auditor supports the Program Compliance and Audits Manager and Supervisor, acting as their liaison when they cannot be present. The incumbent will report information to management that is relevant to maintaining an efficient and productive work environment. This role also exists to provide a first line resource person for the program eligibility auditors on their team, functioning as a decision maker when two auditors do not agree on an audit finding, an educator when an auditor is unclear on an audit process, relevant policy/regulation or audit procedure, an issue/question escalator when necessary and a subject matter expert (SME) on the audit their team is conducting. Responsibilities Include But May Not Be Limited To Conduct eligibility reviews (first or second QA). Conduct medical record & claim error reviews that are a component of the Payment Error Rate Measure (PERM) Review. Develop, implement, generate and revise as necessary dashboard performance reports for Program Compliance and Audits. Develop, implement, generate and revise as necessary orientation program documents for Program Compliance and Audits. Annually update/revise Eligibility review team’s reviewer manual, incorporating federal and state regulatory changes, audit form use updates, reviewer tool use updates, etc. Minimum Qualifications To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month, day and year for each job held.** Three (3) years of experience in program eligibility and/or auditing. Experience Must Also Demonstrate Monitoring and administrating program requirements for eligibility. Investigating, auditing, reviewing, and analyzing diversified procedures and standards. Experience working with MAXIS, METS, MMIS and PRISM or other related data management tools and procedures such as input, collection and retrieval systems. Experience with Microsoft Office applications. A Bachelor’s degree in Public Health, Health and Human Services, public policy, or another related degree field may substitute for one (1) year of professional experience. OR A Master’s degree in Public Health, Health and Human Services, public policy, or another related degree field may substitute for two (2) years of experience. Preferred Qualifications Experience in Healthcare program eligibility or auditing. Experience as a lead worker in program eligibility, auditing, or a related field. Working knowledge of Minnesota’s Health Care and other eligibility programs, regulations, policies and determinations. Variety of experiences working effectively with others from different backgrounds and cultures. Additional Requirements REFERENCE/BACKGROUND CHECKS – DHS will conduct reference checks to verify job-related credentials and a criminal background check prior to appointment. How To Apply Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers. Contact If you have questions about this position, contact Monica Templin at monica.templin@state.mn.us. To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Alexander Duren at alexander.duren@state.mn.us. If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services’ ADA Coordinator at 651-431-4945 or DHS_ADA@state.mn.us for assistance. About Human Services Dept WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential. Working together to improve the state we love. What do Minnesota's State employees have in common? A sense of purpose in their work Connection with their coworkers and communities Opportunities for personal and professional growth Benefits As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well. Your Benefits May Include Paid vacation and sick leave 12 paid holidays each year Low-cost medical, dental, vision, and prescription drug plans Fertility care, including IVF Diabetes care Dental and orthodontic care for adults and children 6 weeks paid leave for parents of newborn or newly adopted children Pension plan that provides income when you retire (after working at least three years) Employer paid life insurance to provide support for your family in the event of death Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury Tax-free expense accounts for health, dental, and dependent care Resources that provide support and promote physical, emotional, social, and financial well-being Support To Help You Reach Your Career Goals Training, classes, and professional development Tuition reimbursement Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov) Employee Assistance Program (EAP) For Work/life Support A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota. EQUAL OPPORTUNITY EMPLOYERS Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law. Applicants With Disabilities Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.

What you’ll do

Conduct eligibility and quality assurance reviews, including medical record and claims error reviews for the Payment Error Rate Measure. Serve as a lead resource and subject matter expert for auditors, resolve disagreements, escalate issues, and develop performance dashboards, orientation materials, and reviewer guidance.

Requirements

Requires three years of experience in program eligibility and/or auditing, including monitoring program requirements, investigating and analyzing procedures, and using eligibility data systems and Microsoft Office. A related bachelor's degree may substitute for one year of experience, or a related master's degree for two years; healthcare eligibility or auditing and lead-worker experience are preferred.

Benefits

• Paid Vacation And Sick Leave
• 12 Paid Holidays
• Health Insurance
• Dental Insurance
• Vision Insurance
• Prescription Drug Plans
• Fertility Care
• Diabetes Care
• Dental And Orthodontic Care
• Paid Parental Leave
• Pension Plan
• Employer-Paid Life Insurance
• Short-Term And Long-Term Disability Insurance
• Tax-Free Expense Accounts
• Training And Professional Development
• Tuition Reimbursement
• Public Service Loan Forgiveness Program
• Employee Assistance Program

Listed skills

• Performance Reporting · Preferred
• Quality assurance · Preferred
• Regulatory Compliance · Preferred
• Microsoft Office · Preferred
• data management · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Program Eligibility
• Auditing
• Eligibility Reviews
• Quality Assurance
• Medical Record Review
• Claims Review
• Payment Error Rate Measure (PERM)
• Performance Reporting
• Dashboard Development
• Training And Orientation Development
• Regulatory Compliance
• Policy Interpretation
• Data Management
• Microsoft Office
• MAXIS
• METS

Job areas

• Government & Public Sector
• Finance & Accounting
• Healthcare
• Management & Leadership
• Data & Analytics

More jobs from Minnesota Direct Care and Treatment