Medicaid Fraud Investigator
Medicaid Fraud Investigator
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$ 55823 - 97689
1 Vacancy
Job Description
Description of Work
This posting is for the following nine 9 positions:
You only need to apply once to be considered for all positions.
Not sure you meet all listed requirements Let our team take a look. Research shows that women and members of other underrepresented groups tend to not apply to jobs when they think they may not meet every qualification. We are committed to creating a diverse and inclusive environment and strongly encourage you to apply.
THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO $55823 to $69000. Salary offers for the selected candidate are based on the candidates education and experience related to the position as well as our agency budget and equity.
*** THESE ARE NONSWORN FINANCIAL INVESTIGATOR POSITIONS***
The primary purpose of these positions is to perform investigations in the area of criminal and civil Medicaid fraud schemes patient abuse or neglect and misappropriation of recipient funds by conducting and participating in wide variety of case investigations involving financial analysis. Work requires knowledge of applicable state and Federal laws and regulations.
Position manages investigative assignments and/or projects by:
- conducting detailed analysis of Medicaid and Medicare claims and reimbursement data.
- preparing detailed spreadsheets and charts analyze flow of payments.
- reviewing and analyze complex medical and billing data as well as medical records.
- preparing written investigation reports serving subpoenas
- conduct surveillance; execute search warrants.
- researching public records; analyzing facts and complex documents.
- interviewing and coordinating witnesses and preparing witness statements and/or affidavits.
- communicating and consulting with subjects law enforcement and judicial personnel Federal and state agencies and others.
- testifying in judicial proceedings.
- maintaining confidentiality and discretion in the course of conducting business.
- working individually and/or with others; and adapting to change and circumstances.
Position will participate in or assist with collection and storage of evidence (to include electronic data and evidence) arrests of search warrants undercover investigation and other law enforcement operations pursuant to the case.
The selected candidate is subject to a background investigation.
Some travel including some overnight stays are required.
Note to Current State Employees:
The salary grade for this position is NC16. State employees are encouraged to apply for positions of interest even if the salary grade is the same as or lower than their current position. Please detail ALL work history including nonstate service experience. If selected for this position a new salary will be recalculated taking into consideration the quantity of relevant education and experience funding availability and internal equity. Based upon these factors a pay increase MAY or MAY NOT result.
The State of North Carolina offers employer paid health insurance plus twelve paid holidays generous vacation and sick leave accrual dental vision and other insurance options and retirement benefits. You can view our benefits information at Employee Benefits.Division Information:
The Medicaid Investigations Division (MID) of the North Carolina Department of Justice which is the Medicaid Fraud Control Unit (MFCU) for the State of North Carolina. Medicaid is the nations public health insurance program for people with low income. This taxpayer funded program provides critical health coverage for nearly one in five people in North Carolina and approximately 40 of children in North Carolina are covered by Medicaid. To date the MID has recovered more than $1 billion in restitution and penalties for North Carolina.
MID investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaidfunded facilities. MID works closely with district attorneys offices US Attorneys offices federal state and local agencies across the State. The damages in a Medicaid fraud case can range from a few thousand dollars to tens of millions of dollars. MIDs enforcement actions protect and recover taxpayer funds and help ensure access to needed medical services for Medicaid enrollees.
MID is staffed by Department of Justice attorneys investigators auditors analysts a nurse investigator paralegals and administrative staff. Cases are pursued in both federal and state courts in partnership with law enforcement agents from federal and state agencies such the Office of Inspector General FBI IRS the North Carolina Department of Insurance Sheriffs Offices and Police Departments.
Department Information:
TheNorth Carolina Department of Justice works to prevent crime and support law enforcement to safeguard consumers and to defend the State its people and their constitutional rights.
Knowledge Skills and Abilities / Competencies
Demonstrated experience investigating criminal offenses within the healthcare industry including Medicaid fraud embezzlement obtaining property by false pretenses patient abuse prescription drug theft and/or other violations related to healthcare providers.
Ability to maintain confidentiality and discretion while conducting criminal and civil investigations.
Ability to work independently or as a part of an investigative team.
Ability to clearly communicate verbal and written information in a clear and concise manner.
Ability to display professionalism while working with witnesses other law enforcement personnel attorneys court personnel medical experts and others.
- Ability to work closely with Federal Law Enforcement agencies and with U.S. Attorneys in a team setting.
Minimum Education and Experience Requirements
Some state job postings say you can qualify by an equivalent combination of education and experience. If that language appears below then you may qualify through EITHER years of education OR years of directly related experience OR a combination of both. See oshr.nc/experienceguide for details.
Bachelors degree in accounting finance business administration or criminal justice from an appropriately accredited institution with eighteen credit hours of accounting coursework and two years of experience in auditing and/or investigating tax financial or securities crimes; or equivalent combination of education and experience.
Necessary Special Requirements: May require certification as a Law Enforcement Officer or Special Agent in accordance with the provisions of the North Carolina Criminal Justice Training and Standards Commission or the ability to achieve certification within one year of employment.Supplemental and Contact Information
Note the following:If multiple applications are submitted to an individual posting only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date.
Resumes and cover letters:To receive credit for your work history and credentials you must list the information on the online application form. This information is used to determine if you meet the requirements of the position and if you are selected it is used to determine a salary offer.
Using the terms See Resume or See Attachment will not be accepted and your application will be rejected as incomplete. Cover letters are highly encouraged but not required.
Transcripts:Degrees must be received from appropriately accredited institutions. A copy of your transcripts indicating the degree received can be uploaded with your application. If a transcript has been requested your application will be considered incomplete if you do not provide one. Using a photograph of your diploma is not acceptable.
Credit for foreign degrees will only be given if verification of degree certification is attached to your application. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine US equivalency.
Any licenses or certificates must be included in the appropriate section of the application form.
Applicants seeking Veterans Preference must attach a copy of their DD214 or discharge orders.
Applicants seeking National Guard Preference must attach a NGB 23A (RPAS) if you are a current member of the NC National Guard in good standing. If you are a former member of the NC National Guard who served for at least 6 years and was discharged under honorable conditions you must attach either a DD256 or NGB 22.
Application status:To check the status of your application please log in to your account. Upon the closing date applications are Under Review and will be screened by Human Resources for the qualified applicants. The hiring process may take an average of 6 8 weeks. All applicants will be notified by email once a position is filled.
If you are having technical issues submitting your application please call the NeoGov Help Line at. If there are any questions about this posting other than your application status please contact the NC DOJ Human Resources office.
The NC Department of Justice is an Equal Opportunity Employer. The NC Department of Justice uses MeritBased Recruitment to select from among the most qualified applicants to fill positions subject to the State Human Resources Act.
CONTACT INFORMATION:
NC Department of Justice
Human Resources
Employment Type
Full-Time
