Research Specialist Iii
4 weeks ago
Research Specialist III**Essential Job Functions**:
1. Performs advanced technical research and in-depth comparative analysis of Medicaid policies and paid claims data to identify, deter, and prevent potential fraud, waste, and abuse in the Medicaid program. (35%)
- 2. Responsible for developing, designing, planning, and conducting and coordinating theoretical studies to validate and test provider compliance with published Medicaid policies, rules, and regulations. Uses data mining expertise and conducts computer based analytical research designed to isolate trends and patterns of potential aberrant provider billing activity or schemes. Uses a variety of advanced statistical methodologies to evaluate outcomes. Leads teams to analyze, establish, recommend, and update procedures for data analysis to improve existing computer-generated reports used in the identification of inappropriately paid claims and/or policy violations. (25%)- 4. Reviews and responds to inquiries regarding legislation, state and federal regulations, and policies and procedures impacting Medicaid and OIG. (15%)
- 5. Attends work on a regular and predictable schedule in accordance with agency leave policy. Participates in OIG special projects and other work as assigned. Keeps manager informed as required or as necessary. (5%)
**Knowledge Skills Abilities**:
**Registration or Licensure Requirements**:
None
**Initial Selection Criteria**:
a. Graduation from an accredited four-year college or university with a degree in public administration, computer science, statistical analysis, research methodology, management, business, or related field is preferred. Experience and education may be substituted for one another.
- b. Experience in healthcare, Medicaid, or other health and human services programs is preferred.
- c. Texas Medicaid Managed Care experience is preferred.
- d. Experience in Microsoft Office is preferred.
**Additional Information**:
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.**MOS Code**:
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
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