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Opportunity Snapshot

If you are passionate about Medicaid program integrity, this company and role is your "dream job". It might seem like overstatement, but consider the facts:

• We're #1 in Medicaid Program Integrity: Health Management Systems (HMS) has always been focused exclusively on the healthcare industry, and we are the leader in the Medicaid marketplace. We have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars and save billions more through cost avoidance.
• HMS is a successful, growing company: Small companies and state governments simply can't offer the resources, compensation and career path that we can. While others are cutting back, HMS is growing: our 2008 revenues of $184 million were up more than 20% over 2007, and and we've maintained that growth rate through the first half of 2009. We are ranked #3 on Fortune's 2009 FSB 100 list of America's fastest growing small public companies.
• Broad systemic impact: This particular role will oversee audits in 11 states and will have a very visible impact on Medicaid fraud, waste and abuse at a national level. Your team will enable the recovery of literally billions of dollars back to the federal government.

If you are ready to take your career to the next level, we look forward to hearing from you.

Our Requirements

• CPA
• At least three years of Medicaid program integrity experience.
• Strong leadership abilities and experience supervising and developing a team of direct reports.
• Solid computer proficiency with Microsoft office suite, including Word & Excel, to prepare reports, memos, summaries and analyses; knowledge of ACL and Teammate Audit Software is a plus.
• Ability to travel up to 15% of the time

Preferred, but not required:

• RN
• Clinician or coding experience in a Pharmacy, Hospital, Nursing Facility, or Primary Physician setting
• Surveillance and Utilization Review experience

More About Your Role

On September 8, 2008, HMS was awarded the first of two Medicaid Integrity Program (MIP) Task Orders by the Centers for Medicare and Medicaid Services (CMS). Under this Task Order, HMS will examine payments to providers made under Title XIX of the Social Security Act, with the objective of identifying potential overpayments made as a result of fraud, waste, or abuse.

HMS will perform these services in the CMS Medicaid Integrity Group (MIG) Dallas Jurisdiction, which includes NM, TX, OK, AR, LA, MT, ND, SD, WY, UT, & CO.

HMS is now the CMS Audit Medicaid Integrity Contractor (Audit MIC) for 22 state and territory Medicaid programs across the country.

The scope of the Audit MIC work is identifying overpayments of Medicaid providers through Medical Review, and the audit team you will supervise will be reviewing medical records and comparing the claims to both the Medical Records and the Medicaid policy governing specific types of services.

Your mission as the Audit Manager will be to ensure audit accuracy and timeliness, monitor audit decisions, prepare and submit required reports, and manage assignments and audit workload. The Audit team is comprised of both HMS and Partner Senior and Staff Auditors who spend the majority of their time (92%) conducting desk reviews and the balance in the field performing on-site audits. Since these audits are clinically focused not billing focused, a key part of your role will be developing the clinical aptitude of your auditors.

The HMS leadership team recognizes the strategic importance of the CMS initiative, and as a result you will have access to the resources you need to make it a success, such as additional staff. You'll find our environment refreshing in its lack of bureaucracy and "red tape."

Keys to Success

Outstanding communication skills are perhaps the most critical success factor for this role as you will be working with and presenting to a variety of individuals and groups, including state departments, Medicaid providers, and the HMS management team. You will also have regular interaction with CMS, including weekly phone calls and, less frequently, in-person meetings. The goal of these meetings will be to ensure client satisfaction and manage expectations. In addition, we'll look to you to keep an eye out for opportunities to expand the current contract or provide services in other areas.

Second to being a great communicator, you'll need to be passionate about our mission. Our bottom line goal is reducing fraud, waste, or abuse, and our most successful - and happiest - audit leaders share in that passion and bring a high level of energy to reaching our targets.

Who We Are

HMS Holdings Corp. (HMS) is the leader in coordination of benefits and program integrity services for government healthcare programs. The company's clients include health and human services programs in more than 40 states, over 90 Medicaid managed care plans, the Centers for Medicare and Medicaid Services (CMS), and Veterans Administration facilities. HMS helps ensure that healthcare claims are paid correctly and by the responsible party. As a result of the company's services, government healthcare programs recover over $1 billion annually, and avoid billions of dollars more in erroneous payments.

We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.

We are an equal opportunity employer. EOE M/F/D/V

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