OAG - Medicaid Fraud Control Unit | Compliance Program Specialist
2 weeks ago
GENERAL SUMMARY
The Medicaid Fraud Control Unit within the Office of the Attorney General (OAG) is in search of a Program Specialist to engage in moderately complex investigative tasks primarily conducted in-house. This role involves thorough research and analysis of data-rich information, reports, and records to uncover evidence supporting the investigation and prosecution of Medicaid fraud infractions, 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 offers exceptional legal services in various legal domains. Employees at the OAG benefit from outstanding perks and have the chance to contribute significantly to a large, dynamic state agency that positively impacts the lives of Texans.
KEY RESPONSIBILITIES
- Conducts in-house investigative activities by gathering and evaluating information, data, and evidence from diverse sources related to allegations of fraud in the Medicaid program, fraud by Medicaid providers, and instances of abuse, neglect, and exploitation in facilities receiving Medicaid funding and other care service providers.
- Prepares comprehensive written analyses and reports, making recommendations based on investigative findings, ensuring alignment with MFCU standards.
- Establishes and nurtures relationships with external agencies, associations, and groups whose collaboration can bolster the MFCU's mission, including the proactive identification of investigative targets.
- Performs additional duties as assigned.
- Maintains up-to-date knowledge essential for executing primary job functions.
- Adheres to a regular work schedule, ensuring consistent attendance.
- Safeguards the security and confidentiality of sensitive and/or protected information.
- Complies with all agency policies and procedures, particularly those related to ethics and integrity.
MINIMUM REQUIREMENTS
- Education: High school diploma or equivalent.
- Education: Bachelor's degree from an accredited institution; relevant experience in fields such as data research, data extraction and analysis, statistical methods, Medicaid, Medicare, healthcare insurance, or white-collar crime investigations may substitute for educational requirements on a year-for-year basis.
- Experience: A minimum of three years of full-time experience in data research, data extraction and analysis, statistical methods, Medicaid, Medicare, healthcare insurance, or related fields.
- 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.
- Ability to work collaboratively in a team-oriented environment.
- Proficient in using spreadsheet applications within a Windows environment.
- Skilled in prioritizing tasks and working under time constraints.
- Proficient in word processing and data entry/retrieval using a computer.
- Able to manage multiple tasks, prioritize effectively, and meet deadlines.
- Strong oral and written communication skills.
- Exhibits sound judgment and effective decision-making abilities.
- Responsive to constructive feedback.
- Capable of providing excellent customer service.
- Willing to work in person at the designated OAG location and engage in collaborative tasks with coworkers throughout the work week.
- Ability to arrange personal transportation for business-related travel.
- Willingness to work beyond 40 hours as necessary and 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 similar roles.
- 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 completed State of Texas application is required for consideration; paper applications are not accepted. Your application may be subject to a criminal background check as per Texas Government Code. Military Crosswalk information is available upon request.
THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER
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