The Investigator VI is selected by and reports to the MPI Intake Manager of the Office of Inspector General. The Investigator performs advance, complex administrative investigative work and/or technical support work for MPI under limited supervision with considerable latitude for the use of initiative and independent judgment. This position maintains and protects confidential information, performs advanced investigative work, which involves researching, reviewing, and investigating allegations of Medicaid Provider fraud, waste and abuse of providers enrolled in various Medicaid provider types.
The work involves investigation, evaluation and analysis of data from ad hoc query reports and detection systems; planning and organizing assigned duties; being familiar with multiple Medicaid programs; utilizing searches of databases and websites to obtain relevant case information; reviewing contracts and financial records; preparing case documents and investigative summaries of research and data analysis; preparing special reports as requested; and testifying in administrative hearings or judicial proceedings as needed. The investigator may be required to participate in meetings on policy and procedures, and/or interpret program policies, standards and procedures for various state and federal agencies. The Investigator VI is responsible for collecting, analyzing, and preparing data for and extracting statistically valid random samples, preparing files for records review, as well as extrapolation of investigative findings for MPI full scale investigations. This position is responsible for generating statistical reports that delineate the status of MPI Investigations; these reports are developed at the request of the MPI Director, MPI Managers and other OIG departments. In addition, this position performs duties as assigned and required to maintain division operations. May plan, assign, and supervise the work of others. Work involves up to 15% travel.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs duties as assigned:
1. Researches, reviews and performs advanced investigative work involving cases alleging Medicaid provider fraud, waste and program abuse or historical non-compliance. Investigative work consists primarily of case-specific research, data collection and analysis, sampling and extrapolations utilizing OIG’s Sampling Tools. (40%)
2. Prepares detailed, comprehensive and grammatically correct reports of highly complex investigative research and data for each case assigned within designated timeframes; completes the administrative duties associated with investigations in conformity with applicable Office of Inspector General-MPI policies and procedures. (10%)
3. Effectively communicates verbally and in writing investigative findings to the MPI Director, Intake Manager of Investigations, other HHSC staff, external agencies, and before administrative, civil and criminal courts if needed. (10%)
4. Develops comprehensive exhibits for case files to ensure a more effective case presentation during informal reviews and/or administrative hearings and court cases. (10%)
5. Conducts interviews (primarily telephonic) with recipients, witnesses, providers, complainants and providers’ staff regarding investigations as needed to support field investigators. (5%)
6. When applicable, develops and recommends program guidelines, procedures, policies, rules and regulations to detect and prevent Medicaid provider fraud, waste and abuse. (5%)
7. Familiar with applicable agency, state and federal directives as applied to investigative responsibilities. (5%)
8. Serves as liaison to other state agencies, licensures boards, and federal agencies regarding Medicaid provider fraud, waste and abuse investigations; interprets program policies, standards and procedures, conducts training workshops, participates in joint investigations, and provides advice and recommendations. (5%)
9. Assists in the development and proper training of investigative staff as well as in the preparation of training and operational manuals, educational materials and information on Program integrity. (5%)
10. Performs other duties as assigned and required to maintain MPI operations. (5%)
Knowledge Skills Abilities:
1. Knowledge of investigative principles, techniques, and procedures; of the laws governing the activities regulated by the agency; and of court procedures, practices, and rules of evidence. 2. Knowledge of Medicaid policies and procedures for all Medicaid programs and knowledge of fraud and abuse rules and regulations and the ability to understand, interpret, and appropriately apply these. 3. Ability in planning, assigning, and/or supervising the work of others; planning, organizing, and conducting investigations, surveys, inspections, and examinations; interpreting and applying laws and regulations; conducting interviews and gathering facts; evaluating findings; preparing concise reports; and testifying in hearings and court proceedings. 4. Ability in communicating effectively both orally and in writing, and to testify under pressure. 5. Ability in establishing and maintaining effective working relationships with supervisory personnel, co-workers, providers, attorneys and individuals from other state and federal agencies and boards. 6. Ability to use personal computers and related software. Word, Excel, MFADS, and Access preferred. 7. Ability to prioritize tasks, work under time constraints and under limited supervision.
Registration or Licensure Requirements:
Initial Selection Criteria:
1. Graduation from an accredited four-year college or university; may substitute education for full-time investigative, white-collar crime, auditing, accounting, Medicaid/Medicare program provider compliance monitoring, healthcare insurance, or closely related experience for required education on a year for year basis. 2. Five years of full time experience in investigations, auditing, or accounting; Medicaid/Medicare program provider compliance monitoring; white collar crime investigations; healthcare insurance or closely related experience. 3. Experience and intermediate to high level proficiency with Microsoft Office Products, particularly Word and Excel; basic knowledge of Access.
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual Chapter 7.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee service center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.