Please paste the following URL into a browser to view the entire job posting in the CAPPS Career Section: https://capps.taleo.net/careersection/ex/jobdetail.ftl?job=00057711
You may apply to the job directly through the CAPPS Career Section. It is not necessary to apply both through Work In Texas and CAPPS Career Section
GENERAL DESCRIPTIONApplicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check and social media check. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment. Applicants must possess a valid driverand#8217;s license.Performs highly complex (senior-level) primarily in-house investigative work by researching and analyzing data-intensive information, reports, and records to identify evidence to support investigation and prosecution of Medicaid fraud violations and physical and financial abuse in Medicaid-funded facilities.Work involves developing, directing, administering, and processing approximately 2,000 referrals a year. Training new staff will be conducted in-person. Works collaboratively with law enforcement, other state agencies, and other partners to ensure timely referral processing; briefs and advises MFCU management on matters concerning Medicaid fraud trends and Medicaid system updates and enhancements.The OAG is a dynamic state agency with over 4,000 employees throughout the State of Texas. As the Stateand#8217;s law firm, the OAG provides exemplary legal representation in diverse areas of law. OAG employees enjoy excellent benefits (https://ers.texas.gov/Benefits-at-a-Glance) along with tremendous opportunities to do important work at a large, dynamic state agency making a positive difference in the lives of Texans.ESSENTIAL POSITION FUNCTIONSPerforms complex in-house investigative work by obtaining and analyzing information, data, and evidence from a variety of sources associated with allegations of fraud in the administration of the Medicaid program, fraud committed by Medicaid providers, and abuse, neglect and exploitation occurring in facilities that receive Medicaid funds and other facilities that provide nursing or personal care services
Possesses advanced knowledge of internal and external applications (Excel, Word, TWC, OnBase, etc.) and databases (Phoenix, Business Objects, etc.), and Healthcare OSINT resources used by MFCU. Queries, examines and analyzes Medicaid claims data, applications, and open sources resources to contribute to an efficient decision-making conclusion.
Make recommendations on the disposition of investigative referral findings by preparing detailed written analysis and reports in a professional, correct, and timely manner, consistent with MFCU guidelines and Texas Medicaid rules.
Develops and/or contributes to others who develop curricula, course outlines, instructional methods, training aids, manuals, and other instructional materials and products.
Conduct briefings to MFCU staff and management
Attend stakeholder meetings
Supervise the work of others to ensure timely, correct, and well-documented referral recommendations.
Performs related work as assigned
Maintains relevant knowledge necessary to perform essential job functions
Attends work regularly in compliance with agreed-upon work schedule
Ensures security and confidentiality of sensitive and/or protected information
Comply with all agency policies and procedures, including those pertaining to ethics and integrity
Qualifications: MINIMUM QUALIFICATIONSEducation: Graduation from high school or equivalent
Education: Bachelor's degree from an accredited college or university; may substitute full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis
Experience: Six years of full-time experience working in the following (or closely related) fields: Healthcare, Teaching, Program Administration
Must be certified as a Texas peace officer by the Texas Commission on Law Enforcement.
Knowledge of Texas Medicaid Program, Claims processing system, Medicaid Rules
Skill in handling multiple tasks, prioritizing, and meeting deadlines
Skill in effective oral and written communication
Skill in exercising sound judgment and effective decision making
Ability to receive and respond positively to constructive feedback
Ability to work cooperatively with others in a professional office environment
Ability to provide excellent customer service
Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG workspace within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave)
Ability to arrange for personal transportation for business-related travel
Ability to work more than 40 hours as needed and in compliance with the FLSA
Ability to lift and relocate 30 lbs.
Ability to travel (including overnight travel) up to 10%PREFERRED QUALIFICATIONSExperience working with the MMIS claims management system.
Experience working as a team member in a collaborate environment
Experience in Medicaid fraud criminal investigations for three years
Knowledge of writing claims queries
Knowledge of Texas Medical Assistance Plan under Title XIX of the Social Security Act (Medicaid)
Skills in using BusinessObjects, Business Intelligence, MCATS, Kintana, Phoenix, e-OPM
Ability to communicate technical guidance and updates to the end user
Ability to formulate learning objectives, to develop training objectives, to evaluate the effectiveness of training, to assess training needs, and to communicate effectively.TO APPLYTo apply for a job with the OAG, electronic applications can be submitted through CAPPS Recruit. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code. Military Crosswalk information can be accessed at https://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_LawEnforcement.pdfTHE OAG IS AN EQUAL OPPORTUNITY EMPLOYER
