Investigative Specialist 1/Trainee 1/Trainee 2

Description

Duties Description

The Division of Medicaid Investigations (DMI) ensures the integrity of the Medicaid program by conducting investigations, recovering overpayments, implementing administrative sanctions against providers. The incumbent will aid in this endeavor using their expertise to assist in the investigation of providers for potential fraud.

The Investigative Specialist 1/Trainee 1/Trainee 2 will function as a member of the Dental Investigations team within the Bureau of Payment Controls & Monitoring in DMI. The incumbent will work as a team member with Dental Service Review Assistant 2, a Public Health Dentist, and an Investigative Specialist 2.

This position has up to 10% travel required for field work.

The duties of the position include, but are not limited to:

• Investigate allegations of Medicaid fraud, waste or abuse.
• Conduct fieldwork, including surveillance and on-site inspections.
• Conduct interviews of witnesses, review records and prepare summaries of findings relating to the alleged activities.
• Utilize various data systems; analyze information; and draw appropriate conclusions.
• Obtain sufficient information and documentation to support investigative findings.
• Conduct complex investigations including drafting correspondence, reports, and notices for public issuance in connection with administrative actions seeking to recoup Medicaid overpayments and impose sanctions.
• Testify at administrative hearings as necessary.
• Ensure full compliance with the Investigative Case Management Process.
• Collaborate with other regulatory oversight agencies and law enforcement and conduct joint investigations as appropriate.
• Conduct data mining of dental provider claims and compile findings and analyses into narrative and statistical reports.
• Draft correspondence, referrals to other agencies, and notices of agency actions seeking sanctions and recoveries of overpayments when appropriate.
• Respond to provider correspondence and inquiries.
• Review documents for quality and consistency, ensuring compliance with applicable laws, rules, or regulations.
• Collaborate with Dental Team/Unit staff on investigations.
  
  

Qualifications

Minimum Qualifications

Appointment to the Trainee 1 level requires:

Four years of investigative experience OR an associate degree and two years of investigative experience OR a bachelor’s or higher degree.

Appointment To The G-18 Level Requires

Six years of experience in a field investigative position conducting interviews of witnesses and others, taking written statements and affidavits, collecting and analyzing physical and documentary evidence, and preparing detailed written reports of investigative findings.

NON-QUALIFYING Investigative Experience includes but may not be limited to: Experience in routine police patrol work, security guard or related security position, tax collector, collector of delinquent accounts, credit checker, legal assistant/attorney, hotel or store detective, loss prevention officer, parole officer, correction officer, guard, inspector, or experience in adoption and/or foster care placement.

Substitutions for the full G-18 title: An associate degree in criminal justice or related field may substitute for two years of qualifying experience. A bachelor’s degree in criminal justice or a related field may substitute for four years of qualifying experience. Related fields include law enforcement, police science, criminal justice administration, criminology, criminal investigation, police studies, public justice, forensic accounting, forensic psychology, forensic science, and economic crime management.

PREFERRED QUALIFICATIONS: Excellent verbal and written communication skills. Proficiency with Microsoft Office Suite Products and ability to learn new systems. Ability to analyze and apply data to investigations. Understanding of the services provided to Medicaid participants.

Additional Comments

Non-Competitive, permanent, full-time position. There will be minimal mandatory overtime. Candidates with no prior state history will start at a starting salary of $53,764 for the Trainee 1 position. The starting salary for the full G-18 is $66,951. The starting salaries are NON-NEGOTIABLE.

There will be minimal mandatory overtime.

Routine travel is required in order to conduct fieldwork necessary to complete investigations. Must have a valid driver’s license or otherwise demonstrate the ability to meet the transportation requirements of the position.

• Please be aware that because of the nature of the position an appointment is subject to satisfactory completion of fingerprinting and background check.
  
  

The Office of the Medicaid Inspector General is proud to be an equal opportunity employer. We encourage those with unique backgrounds and contributions such as education, culture, ethnicity, race, sex, gender identity and expression, nation of origin, age, languages spoken, veteran’s status, color, religion, disability, sexual orientation, and beliefs to apply.

We provide reasonable and religious accommodations for any part of the application and hiring process. If you have a disability or special need that requires accommodation, please send a request to [email protected]