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OAG - Medicaid Fraud Control Unit | Investigative Program Specialist
2 months ago
GENERAL SUMMARY
The Medicaid Fraud Control Unit within the Office of the Attorney General (OAG) is on the lookout for a Program Specialist who will engage in moderately complex investigative tasks primarily conducted in-house. This role involves the research and analysis of data-rich information, reports, and records to uncover evidence that supports the investigation and prosecution of Medicaid fraud offenses, as well as physical and financial abuse in facilities funded by Medicaid.
The OAG is a vibrant state agency employing over 4,000 individuals across Texas. As the legal representative of the state, the OAG provides outstanding legal services in various legal domains. Employees at the OAG benefit from excellent perks and have significant opportunities to contribute meaningfully at a large, dynamic state agency, positively impacting the lives of Texans.
KEY RESPONSIBILITIES
- Conducts in-house investigative activities by gathering and analyzing information, data, and evidence from diverse sources related to allegations of fraud in the Medicaid program, fraud by Medicaid providers, and abuse, neglect, and exploitation in facilities receiving Medicaid funding and other care service establishments.
- Prepares detailed written analyses and reports in a professional and timely manner, making recommendations based on investigative findings in alignment with MFCU guidelines.
- Establishes and nurtures relationships with external agencies, associations, and groups that can support the MFCU's mission, including the proactive identification of investigative targets.
- Performs additional related duties as assigned.
- Maintains up-to-date knowledge essential for executing core job functions.
- Regularly attends work in accordance with the agreed-upon schedule.
- Ensures the security and confidentiality of sensitive and/or protected information.
- Adheres to all agency policies and procedures, including those concerning ethics and integrity.
MINIMUM REQUIREMENTS
- Education: High school diploma or equivalent.
- Education: Bachelor's degree from an accredited institution; relevant experience in related fields may substitute for the required education on a year-for-year basis, including full-time data research and compilation, data extraction/query and analysis, statistical methods, and investigations related to Medicaid, Medicare, or healthcare insurance.
- Experience: A minimum of three years of full-time experience in data research and compilation, data extraction/query and analysis, statistical methods, or related investigative experience.
- Proficient in interpreting complex regulations and guidelines.
- Adept at learning new or evolving computer systems and databases.
- Skilled in producing concise, professional-quality documents and reports.
- Capable of establishing and maintaining effective working relationships with management and colleagues.
- Effective in collaborating within a team-oriented environment.
- Proficient in using spreadsheet applications in a Windows setting.
- Ability to prioritize tasks and operate under time constraints.
- Competent in word processing and data entry/retrieval using a computer.
- Skilled in managing multiple tasks, prioritizing, and meeting deadlines.
- Effective in both oral and written communication.
- Exhibits sound judgment and decision-making capabilities.
- Open to receiving and responding positively to constructive feedback.
- Ability to work collaboratively in a professional office setting.
- Committed to providing excellent customer service.
- Willingness to work in person at the designated OAG location and engage in collaborative tasks with coworkers throughout the workweek.
- Ability to arrange personal transportation for business-related travel.
- Willingness to work beyond 40 hours as necessary, in compliance with FLSA regulations.
- Ability to lift and move 30 lbs.
- Willingness to travel (including overnight travel) up to 5% of the time.
- Knowledge of the Texas Medical Assistance Plan under Title XIX of the Social Security Act (Medicaid).
- Experience in researching Medicaid program regulations.
- Experience in performing intake duties.
- Experience in conducting preliminary investigations of complaints.
- Experience as a business analyst, investigative analyst, intelligence analyst, or in a closely related role.
- Familiarity with Texas Medicaid databases.
- Proficient in Business Objects, Microsoft Word, Excel, Access, and Outlook.
To apply for a position with the OAG, electronic applications must be submitted through CAPPS Recruit. A State of Texas application is required for consideration, and paper applications will not be accepted. Your application may be subject to a criminal background check in accordance with the Texas Government Code. Military Crosswalk information is available for reference.
THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER
