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Management Analyst IV
1 month ago
The Management Analyst IV performs highly advanced (senior-level) research, data reporting and analysis, and investigative work for the Chief Counsel Division of the Texas Health and Human Services Office of Inspector General.
The Management Analyst IV will work with attorneys, legal assistants, and other staff on complex cases involving fraud, waste, and abuse in the Medicaid system as well as other health and human services programs.
The work involves reviewing, researching, analyzing, and evaluating investigative findings; developing database queries and reports; reviewing medical and dental claims records; and presenting information orally and in writing.
May serve as team lead over other support staff and assist Chief Counsel leadership on various administrative matters. May train support staff and attorneys.
Duties and responsibilities primarily involve work falling under the purview and direction of the Deputy Inspector General for Complex Litigation.
Works under the supervision of the Chief Counsel Office Manager, with extensive latitude for the use of initiative and independent judgment.
Essential Job Functions:
Researches, collects, queries, and analyzes data using standard database tools, applications, methods, and techniques. Develops standard database queries and report templates. (25%)
Reviews, analyzes, and evaluates evidence and documents obtained from investigations. Identifies areas requiring further review and summarizes findings. (25%)
Researches Medicaid policy and medical and dental claims and coding requirements. Reviews results of claims data analysis. (25%)
Coordinates with program areas of the Office of Inspector General, including investigations, policy, audit, data analysis, medical and dental review. Coordinates with program areas of Texas Health and Human Services on matters of policy. (20%)
Performs related work as assigned. Keeps supervisor informed as required or as necessary. (5%)
Knowledge Skills Abilities:
Knowledge of health and human services programs, functions, and systems, including related local, state, and federal laws and regulations.
Experience in the investigation of fraud, waste, and abuse within health care systems.
Experience in in data analysis, research, compilation, and reporting work.
Knowledge of developing queries, designing reports, and presenting findings derived from internal and external database sources.
Skill in conducting data searches, in evaluating and translating large amounts of data, and in critical thinking.
Knowledge and application of reporting methodologies and tools, such as Business Objects, OnBase, Tableau, and similar applications.
Knowledge of the Texas Medicaid program, including applicable state and federal laws, regulations, rules, policies, and requirements.
Knowledge of the Texas Medicaid program delivery models, including fee-for-service and managed care.
Knowledge of medical and dental claims coding (including CPT, HCPCS, and CDT codes) and claims submission procedures, processes, and requirements.
Skill in communicating effectively orally and in writing and in presenting information.
Proficiency in use of computer software applications including, but not limited to Microsoft Office (Outlook, Word, Excel, PowerPoint, SharePoint, and Teams), Adobe Acrobat Pro, and database programs.
Experience in performing research using resources including, but not limited to Westlaw, LexisNexis Accurint, PACER, agency and court case management systems, and legislative reference sources.
Experience in performing research using resources including, but not limited to systems and databases maintained by the Centers for Medicare & Medicaid Services (CMS), Texas Medicaid & Healthcare Partnership (TMHP), U. S. Department of Health and Human Services (HHS), and Texas Health and Human Services.
Ability to use common office equipment including, but not limited to computers, printers, copiers, and audio-visual systems.
Ability to organize work, prioritize time, and manage multiple deadlines.
