Investigator III
Location: Austin, Texas
Description: Texas Department of Family and Protective Services is at the momment seeking for Investigator III right now, this job will be settled in Texas. Further informations about this job opportunity please give attention to these descriptions. The Investigator III is selected by and reports to the MPI Intake & Sampling Unit Manager of the Office of Inspector General. The Investigator performs moderately complex ! investigations and/or technical support work for MPI under general supervision with limited latitude for the use of initiative and independent judgment. This position maintains and protects confidential information, performs advanced integrity/preliminary investigative work, which involves researching, reviewing, and investigating allegations of Medicaid Provider fraud, waste and abuse (cases and complaints) with focus on the appropriateness of utilization of Medicaid funds and/or services.
The Investigator III will use computer-based analytical and statistical tools to research, coordinate, and validate complaints and/or allegations of potential fraud, waste or abuse by Medicaid providers regarding the utilization and appropriateness of services by identifying patterns and trends. The Investigator III analyzes detection systems, participates in meetings on policy and procedures and/or interprets program policies, and makes referrals to Texas Medicaid Healthcare Pa! rtnership (TMHP), licensure boards and other state and federal! agencies. In addition, this position performs duties as assigned and required to maintain division operations. Work involves 10% travel.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs duties as assigned:
1. Researches, reviews and investigates complaints and referrals alleging Medicaid provider fraud, waste and abuse or historical non-compliance. (25%)
2. Prepares detailed, comprehensive and grammatically correct preliminary investigative reports, referral letters to outside entities and closure memoranda for highly complex investigations for each case assigned within designated timeframes; completes the administrative duties associated with investigations in conformity with applicable Office of Inspector General-MPI policies and procedures. (20%)
3. Effectively communicates investigative findings to the MPI Director, Intake & Sampling Unit Manager or Intak! e Lead, other HHSC staff, external agencies, and before administrative, civil and criminal courts as needed. (20%)
4. When applicable, develops and recommends program guidelines, procedures, policies, rules and regulations to detect and prevent Medicaid provider fraud, waste and abuse. (5%)
5. Serves as liaison to other state agencies, licensure boards, and federal agencies regarding complaints and investigations. (5%)
6. Performs case management functions to ensure all referrals and complaints received by MPI are assigned a tracking number and that investigative activities and status of cases are accurately maintained and reported in the MPI Case Management system. (10%)
7. Conducts interviews with clients, witnesses, providers, complainants and providers’ staff regarding preliminary investigations. (10%)
8. Performs other duties as assigned and required to maintain MPI operations. (5%)
Knowledge Skills Abilities:
1. Knowledge of i! nvestigative principles, techniques and procedures.
2. Knowledge of! the laws governing the activities regulated by the agency.
3. Knowledge of court procedures, practices and rules of evidence.
4. Knowledge of Medicaid policies and procedures for all Medicaid programs and knowledge of fraud and abuse rules and regulations; ability to understand, interpret, and appropriately apply policies, rules, regulations and laws.
5. Knowledge of office procedures.
6. Skill in performing research.
7. Skill in using word processing software, spreadsheets and databases. Experience in Word, Excel, Access; knowledge of Phoenix, MFADS, Business Objects, or similar databases preferred.
8. Ability to maintain confidential information.
9. Skill in preparing correspondence, reports, letters and memorandums.
10. Ability to communicate effectively in writing and verbally.
11. Ability to analyze and compile data and pay close attention to detail.
12. Ability to work independently with general supervision, limited latitude, a! nd with initiative and independent judgment.
13. Ability to efficiently manage and prioritize multiple tasks and to work under pressure and time constraints; analyze and solve problems.
14. Ability to set up and maintain complex filing and tracking systems.
15. Ability to establish and maintain effective working relationships with supervisory personnel, co-workers, providers, attorneys and individuals from other state and federal agencies and boards; while maintaining sensitive and confidential information.
16. Ability to travel 10% of the time.
Registration or Licensure Requirements:
None.
Initial Selection Criteria:
1. Graduation from an accredited four-year college or university; may substitute education for full-time investigative, white-collar crime, auditing, accounting, Medicaid/Medicare program provider compliance monitoring, healthcare insurance, or closely related experience for required education on a year f! or year basis. 2. Experience and proficiency with Microsoft Office Prod! ucts, particularly Word and Excel. 3. Health care knowledge preferred. 4. Medicaid provider/healthcare investigative or auditing experience preferred. 5. Experience with databases and ad-hoc reports related to health care data; Phoenix, MFADS (FICO-IFM), and Business Objects, is preferred. 6. Career experience track record that suggests compatibility with the position level responsibilities and duties; track record that suggests a history of initiative, and of contributing substantially beyond the basic job requirements.
Additional Information:
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual Chapter 7.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the ! hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee service center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
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If you were eligible to this job, please deliver us your resume, with salary requirements and a resume to Texas Department of Family and Protective Services.
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This job will be started on: Thu, 16 May 2013 06:44:19 GMT