Working Title: Provider Eligibility and Compliance Specialist

Job Class: Human Services Program Specialist 1

Agency: Human Services Dept

Job ID: 94311 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: 06/17/2026 Closing Date: 06/30/2026 Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office Division/Unit: DHS-Central Office / HCA MPPS PEC HC Non Physician Work Shift/Work Hours: Day Shift Days of Work: Monday - Friday Travel Required: No Salary Range: $23.98 - $34.69 / hourly; $50,070 - $72,432 / annually Classified Status: Classified Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE FLSA Status: Nonexempt Re-Posting: Yes Designated in Connect 700 Program for Applicants with Disabilities: Yes

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 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 was previously announced on 06/05/2026. If you already applied for this job, you do not need to reapply.

This position exists to screen, enroll and maintain provider records to ensure State and Federal requirements are met to reduce Medicaid fraud, waste and abuse.

Required

Minnesota Health Care Programs (MHCP) enrolls more than 70 types of individual and organizational providers to serve our recipients and receive payment for those services. More than 250,000 individual and organizational providers are enrolled and required to sign a provider agreement and abide by and accept state and federal policies and payments. Each provider type is unique and must meet specific criteria to enroll. Provider Eligibility & Compliance (PEC) is responsible for:

Creating and maintaining provider enrollment criteria and procedures; Determining the eligibility of these providers; Processing initial enrollment applications; Working with these providers to maintain MHCP eligibility through ongoing screening, certification, and licensure and evolving program requirements

PEC is charged with managing and maintaining the data in the MMIS/MPSE provider subsystem. We partner with the DHS OIG, the Attorney General's (AG) office, and other state and federal agencies to maintain the integrity of our provider data and to prevent fraud, waste and abuse in our health care programs. PEC oversees the central repository of the supporting documentation that is required as proof in order to enroll MHCP providers.

The PEC Specialist Responsibilities Include

Analysis, interpretation and application of internal, state, federal and national requirements for determining the eligibility and enrollment of counties, health care providers, provider groups and other health care entities providing services to enrollees in the Medicaid program Monitoring, review and verification of provider information to determine impact on eligibility, type, and level of reimbursement Research and respond to inquiries regarding provider enrollment and compliance with policy, procedures and decisions. Research, draft and analyze findings of ad hoc studies and reports related to PEC policies and activities Investigate, review and prepare recommendations for modifications, changes, and edits to systems, operations, policies and procedures

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.**

2 years advanced administrative support, paraprofessional, or technical experience

OR

Associate degree in related field and 1 year advanced administrative support, paraprofessional, or technical experience

OR

Bachelor’s degree in related field

Experience Must Include The Following

Experience with policies, procedures, and operations associated with Medicaid provider enrollment process and eligibility criteria Experience reviewing applications and determining eligibility Experience with MPSE, MMIS or other claims processing subsystems

Preferred Qualifications

Understand and translate technical information into appropriate lay language Accurately and appropriately respond to sensitive and legally/politically volatile provider eligibility and compliance issues Handle complaints and apply good customer service techniques Effectively use standard office software, such as Microsoft Outlook, Word, and Excel Variety of experiences working effectively with others from different backgrounds and/or cultures

Additional Requirements

To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.

This Position Requires Successful Completion Of The Following

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

Criminal background check Reference check Fingerprinting check (MNJIS/CJIS)

Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3 business days from the start of employment; and successfully obtain/retain CJIS certification annually.

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 the position, contact Jaqueline Ramirez at jaqueline.ramirez@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 JaKeya Spencer at JaKeya.Spencer@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.