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OAG - Medicaid Fraud Control Unit | Program Analyst II

2 months ago

Austin, Texas, United States CAPPS, Inc. Full time
Job Overview

GENERAL SUMMARY

The Medicaid Fraud Control Unit within the Office of the Attorney General (OAG) is in search of a Program Specialist who will engage in moderately complex investigative tasks primarily conducted in-house. This role involves the thorough 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 with a workforce exceeding 4,000 employees 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 excellent perks and have the chance to contribute significantly to a large, dynamic agency that positively impacts 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, including fraud by Medicaid providers and instances of abuse, neglect, and exploitation in facilities receiving Medicaid funding and other care service establishments.
  • Prepares detailed written analyses and reports to recommend actions based on investigative findings, ensuring compliance with MFCU guidelines and maintaining professionalism, accuracy, and timeliness.
  • Establishes and nurtures relationships with external agencies, associations, and groups whose collaboration can enhance the MFCU's mission, including the proactive identification of investigative targets.
  • Performs additional related duties as assigned.
  • Maintains current knowledge essential for executing primary 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, particularly those related to ethics and integrity.
Qualifications:

MINIMUM REQUIREMENTS
  • Education: High school diploma or equivalent.
  • Education: Bachelor's degree from an accredited institution; relevant experience in closely 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, healthcare insurance, or white-collar crime.
  • Experience: A minimum of three years of full-time experience in researching and compiling data, data extraction/query and analysis, statistical methods, and investigations related to Medicaid, Medicare, healthcare insurance, or similar fields.
  • Proficient in interpreting complex regulations and guidelines.
  • Adept at learning new or evolving computer systems and databases.
  • Skilled in drafting concise, professional-quality documents and reports.
  • Capable of fostering effective working relationships with management and colleagues.
  • Ability to collaborate effectively in a team-oriented environment.
  • Proficient in using spreadsheet applications within a Windows environment.
  • Skilled in prioritizing tasks and working under tight deadlines.
  • Proficient in word processing and data entry/retrieval using a computer.
  • Able to manage multiple tasks, prioritize effectively, and meet deadlines.
  • Effective oral and written communication skills.
  • Demonstrates sound judgment and decision-making abilities.
  • Receptive to constructive feedback.
  • Ability to work collaboratively in a professional office setting.
  • Strong customer service orientation.
  • Willingness to work in person at the designated OAG location and perform all assigned tasks on-site.
  • 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.
PREFERRED QUALIFICATIONS
  • Knowledge of the Texas Medical Assistance Plan under Title XIX of the Social Security Act (Medicaid).
  • Experience in researching Medicaid program rules and 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.
APPLICATION PROCESS

To apply for a position with the OAG, candidates must submit electronic applications through CAPPS Recruit. A completed State of Texas application is required for consideration, and paper applications are not accepted. Please note that your application may be subject to a criminal background check as per Texas Government Code.

THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER