Investigator IV
Location: Austin Texas
Description: Health & Human Services Comm is employing Investigator IV right now, this vacancy will be placed in Texas. For detail informations about this vacancy opportunity please read the description below. The Investigator IV is selected by and reports to the MPI Intake Manager of the Office of Inspector General. The Investigator performs complex (journey-level) investigative work and/or technical support work for MPI under general supervision with moderate latitude for the use of initiative and independent judgment. The Investigator IV may train other staff. This position performs preliminary investigative work, which i! nvolves researching, reviewing, and investigating allegations of Medicaid Provider fraud, waste and abuse with focus on the appropriateness of utilization of Medicaid funds and/or services.
The Investigator IV uses computer-based analytical and statistical tools to research, coordinate, or validate/disprove allegations of provider fraud, waste or abuse. This position utilizes detection systems, interprets program policies, and makes referrals to outside entities. The Investigator IV performs case management functions for MPI which includes opening, assigning, monitoring and updating case in the Case Management database. The Investigator IV is responsible for generating statistical reports that delineate the status of MPI Investigations and on request reports. In addition, this position performs duties as assigned and required to maintain division operations.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordanc! e with agency leave policy and performs other duties as assign! ed.
1. Researches, reviews and investigates complaints and referrals alleging Medicaid provider fraud, waste and abuse or historical non-compliance completing the required established minimum number of cases per month. (45%)
2. Prepares detailed, comprehensive and grammatically correct preliminary investigative reports, referral letters to outside entities and closure memoranda for 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. Effectively communicates investigative findings to the management at all levels including other HHSC staff, external agencies, and before administrative, civil and criminal courts if needed. (20%)
3. Reviews investigative procedures and recommends improvements to policies and procedures, rules and regulations to detect and prevent Medicaid provider fraud, was! te and abuse. (5%)
4. Serves as resource to other state agencies, licensures boards, and federal agencies regarding complaints and investigations. (5%)
5. Performs case management functions and generates statistical reports to document performance measures of MPI investigative activity and special requests. (10%)
6. Conducts interviews with recipients, witnesses, providers, complainants and providers’ staff regarding preliminary investigations. (5%)
7. Assists in the development of training materials and training of staff. (5%).
8. Performs other duties as assigned and required to maintain MPI operations. (5%).
Knowledge Skills Abilities:
1. Ability to apply investigative principles, techniques and procedures.
2. Ability to analyze and compile data and pay close attention to detail.
3. Ability to research and correctly apply Medicaid policies, rules, regulations and laws.
4. Ability to effectively use word processing sof! tware, spreadsheets and databases.
5. Ability to maintain confident! ial information.
6. Ability to effectively communicate both orally and in writing thru clear, concise and grammatically correct correspondence, reports, letters and memorandums.
7. Ability to work independently with general supervision, moderate latitude for the use of initiative and independent judgment.
8. Ability to efficiently manage and prioritize multiple tasks and to work under pressure and time constraints producing required number of cases per month.
9. Ability to maintain filing and tracking systems.
10. 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.
Registration or Licensure Requirements:
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Initial Selection Criteria:
Graduation from an accredited high school or GED. Two years of college or associates d! egree. Experience in investigations, white-collar crime, auditing, accounting, application of Medicaid policies, procedures and regulations, or closely related experience.
Additional Information:
Requisition ID# 240103
Must be willing to travel 10% of the time. Must be willing to work overtime as needed. Works with automated systems. Must be able to type. Experience using Microsoft Word and Microsoft Excel is preferred.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide
reasonable accommodation during the hiring and selection process for qualified individual
s with a disability. If you need assistance completing the on-line application, contact
the CAPPS 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 va! cancy, please email us your resume, with salary requirements and a resu! me to Health & Human Services Comm.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Tue, 25 Feb 2014 18:12:06 GMT