Quality Assurance and Improvement Analyst​/Human Services Program Representative

Work Information

Working Title:

Quality Assurance and Improvement Analyst

Job Class:
Human Services Program Representative 2

Agency:
Human Services Dept

Telework Eligible:
Yes

Job

Location:

St. Paul

Full/Part Time:
Full-Time

Regular/Temporary:
Unlimited

Who May Apply:
Open to all qualified job seekers

Date Posted: 01/16/2026

Closing Date: 01/29/2026

Hiring Agency/Seniority Unit:
Human Services Dept / MAPE DHS Central Office

Division/Unit: DHS-Central Office / HCA MPPS Prov Elig Compl

Work Shift/

Work Hours:

Not Applicable Shift

Days of Work:
Monday - Friday

Travel Required:

No

Salary Range: $32.40 - $47.76 / hourly; $67,651 - $99,722 / 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.

This position exists to protect the integrity of Minnesota Health Care Programs by identifying errors, gaps and trends to reduce Medicaid fraud, waste and abuse. The role provides recommendations to improve policies, procedures, training and legislation, ensuring consistent and efficient provider enrollment processes. Acting as a subject matter expert, the role applies comprehensive knowledge of MHCP systems and regulations to maintain program integrity and support ongoing modernization efforts.

This person is the SME and ensures all MHCP provider requests are appropriately screened and have eligibility determinations according to State and Federal laws and program policies.

• Reviews and evaluates MHCP approved and denied enrollment requests to determine if the program is achieving its objectives by outlining report criteria and reviewing results in order to propose solutions, resolve problems discovered during the evaluation, and monitor outcomes. Documents problems and solutions, while continually analyzing and organizing data to ensure the integrity of program activity in relation to enrollment of qualified providers.
• Represents the Member and Provider Services (MPS) Division at meetings with internal and external stakeholders to ensure that adequate information is effectively communicated within program guidelines.
• Provides technical assistance to DHS staff and works with others on joint projects related to provider screening and enrollment activities and proper payment of claims.
• Advise stakeholders (MHCP program and service policy staff, MN.IT, state and federal auditors, DHS OIG, Attorney General's Office, DHS FOD, provider associations and other provider stakeholder groups) with a comprehensive understanding of all procedural and technical aspects of program activities in relation to enrollment activities and system coding so that requested supports are within the limitations of the regulations and policies involved;
  
  assessing whether or not program parameters have been met; analyzing resource distribution to avoid duplication within or between programs; verifying that provided services are consistent with program plans. Provides on‑site technical assistance, training and presentations on the Provider Enrollment processes.
• Determines compliance with MHCP programs so that management is kept up to date on program activities, and program needs are identified by monitoring and identification of issues and problems, such as systems logic applicable to meet State and Federal regulations.
• Conducts detailed and comprehensive research of the Minnesota Provider Screening Enrollment Portal (MPSE) and MMIS system change requests to proactively identify changes that will affect the integrity of the enrollment process so that program activities, program needs, and future program services are identified and addressed.
• Provides enrollment expertise to external and internal stakeholders regarding the integrity of decisions to approve, deny, terminate, or take other action on a provider record by testifying in court cases and/or working with auditors.
• Implements enrollment status changes that affect financial reporting systems for state, federal, and other funding sources. Determines when it is necessary to notify other appropriate business areas, such as policy areas or claims processing, of action taken on a provider record and ensures the necessary communication is documented.
• Develops recommendations for enhancements or changes in legislation that enable Provider Enrollment to continue adding efficiencies to the processes for both DHS and providers.

• 3 years professional experience with Minnesota Health Care Programs (MHCP) operations or similar healthcare/insurance related experience. Experience must include the following:
  • Experience with compliance requirements for healthcare programs.
  • Experience with conducting quality and compliance review…