OAG - Medicaid Fraud Control Unit | Sergeant |

1 week ago

San Antonio, Texas, United States CAPPS, Inc. Full time
Job Description

GENERAL DESCRIPTION

Performs advanced criminal investigations of Medicaid provider fraud and nursing home related investigations for the Office of the Attorney General's Medicaid Fraud Control Unit (MFCU). Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. OAG employees enjoy excellent benefits along with tremendous opportunities to do important work and make a positive difference in the lives of all Texans.

JOB POSTING NOTICE

Applicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check. The MFCU works cases jointly with other law enforcement agencies including the FBI, U.S. Department of Health and Human Services - Inspector General and IRS. In certain cases, it is necessary for our staff to have a Top Secret security clearance in order to fully participate in joint investigations or in task force activities. Top Secret clearances are not required prior to employment but in certain cases may be required at a later date. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment.

ESSENTIAL POSITION FUNCTIONS
  • Conducts complex criminal investigations of Medicaid provider fraud, and/or assures that nursing home related investigations are addressed professionally and in a timely manner, utilizing a wide range of techniques, with the goal of accomplishing the primary mission of MFCU, bringing violators of state and federal law, over which MFCU has jurisdiction, to justice, and identifying Medicaid and Medicaid related overpayments to Medicaid providers
  • Plans, participates in and conducts undercover investigations, surveillance operations, raids, and searches; identifies, gathers, and examines evidence, including complex records of Medicaid providers; executes court orders, warrants, and subpoenas; and reports investigative findings
  • Establishes and maintains liaison with outside agencies, associations, groups, and the like whose assistance and cooperation can enhance the mission of MFCU, including but not limited to proactive generation of investigative targets; participates willingly in team investigative endeavors (intra-Team, inter-Team, inter-city, and inter-agency); and contributes to a positive work environment and high morale
  • May train, lead, and/or assist with the work of others.
  • Performs related work as assigned
  • Responds to emergency situations by serving on-call twenty-four hours per day/seven days per week
  • Maintains relevant knowledge necessary to perform essential job functions
  • Attends work regularly in compliance with agreed-upon work schedule
  • Ensures security and confidentiality of sensitive and/or protected information
  • Complies with all agency policies and procedures, including those pertaining to ethics and integrity
Qualifications:

MINIMUM QUALIFICATIONS
  • Education: Graduation from high school or equivalent
  • Education: Sixty credit hours from an accredited college or university; may substitute an associate's or bachelor's degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis
  • Experience: Four years full time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer TCOLE certification
  • Knowledge of TCOLE training requirements and healthcare fraud investigation training needs
  • Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook)
  • Knowledge of criminal investigative principles, techniques, and methodologies
  • Knowledge of management and administrative principles, techniques, and methodologies
  • Knowledge of agency goals, objectives, rules, regulations, policies, and procedures
  • Knowledge of state and federal statutes, rules, and regulations pertaining to law enforcement activities
  • Knowledge of criminal and civil court proceedings and rules of evidence
  • Skill in effective oral and written communication (Writing sample will be required at time of interview, if selected)
  • Skill in researching and interpreting complex rules and regulations
  • Skill in applying investigative techniques and procedures
  • Skill in handling multiple tasks, prioritizing, and meeting deadlines
  • Skill in exercising sound judgment and effective decision making
  • Ability to develop and implement strategic plans and budgets
  • Ability to use and care for firearms
  • Ability to use intermediate impact weapons and Oleoresin Capsicum spray
  • Ability to use physical tactics
  • Ability to conduct complex criminal investigations of Medicaid provider fraud and nursing home related investigations
  • Ability to interpret and apply applicable provisions of the Texas Penal Code, the Texas Code of Criminal Procedure, and federal statutes pertaining to investigations
  • Ability to interpret and apply department policies and procedures
  • Ability to plan, assign, and supervise the work of others
  • Ability to handle stressful situations
  • Ability to receive and respond positively to constructive feedback
  • Ability to work cooperatively in a professional office environment
  • Ability to provide excellent customer service
  • Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave)
  • Ability to arrange for personal transportation for business-related travel, with reimbursement
  • Ability to work more than 40 hours as needed and in compliance with FLSA
  • Ability to lift and relocate 30 lbs.
  • Ability to travel (including overnight travel) up to 20%
  • Ability to achieve 64% or better of VO2 max on the 2000-meter row, or meet a minimum score of 64% on the 500-meter row test or 4-minute row test, utilizing a Concept 2 Rower
PREFERRED QUALIFICATIONS
  • Experience conducting white collar/economic crime investigations
  • Experience investigating healthcare provider fraud and working with state and federal prosecutors in criminal matters
  • Accomplished practitioner of the MFCU documentation and report writing system or a like system
  • Knowledge of healthcare fraud statutes (state and federal)
TO APPLY

To apply for a job with the OAG, electronic applications can be submitted through CAPPS Recruit. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code. Military Crosswalk information can be accessed at

THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER

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