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Investigator VII

Company: Texas State Job Bank
Posted on: May 3, 2021

Job Description:

Job/Position DescriptionInvestigator VII (Lead):Performs highly advanced specialized and oversight (senior-level) investigative work which involves researching, reviewing and investigating Medicaid fraud, waste and program abuse cases and complaints; analyzing detection systems; developing methodologies for detection and evaluation; analyzing and interpreting business, financial and medical documentation; participating in meetings on policy and procedures; applying/interpreting program policies, standards and procedures; and coordinating investigative activities with other Office of Inspector General [OIG] divisions, the Office of the Attorney General [OAG], federal law enforcement agencies, state licensure boards, and/or other external entities. Provides testimony and presents evidence in formal hearings and/or court proceedings, when required. Advises, coordinates, and leads investigative teams. Assists investigators with developing fraud, abuse and/or waste cases. Assists with the development of guidelines, procedures and policies for conducting investigations to enhance and improve the results of investigative activities and division operations. May plan, assign, and/or supervise the work of others. Performs other duties as assigned and required to maintain unit operations. Works under minimal supervision with extensive latitude for the use of initiative and independent judgment. Work involves up to 50% travel; work hours other than 8AM to 5PM. Work involves viewing computer screens for long periods of time. Essential Job Functions1. Researches, reviews, investigates and oversees the investigation of highly advanced complaints and cases alleging Medicaid provider fraud, waste, and/or abuse recommending action(s) as appropriate. Gathers, analyzes and interprets business, financial and medical documentation. Advises, coordinates and leads investigative teams. Advises, coordinates, and leads investigative teams with developing fraud, abuse, and/or waste cases (35%). 2. Evaluates, summarizes and communicates investigative findings through various oral and written communications. Prepares detailed, comprehensive and grammatically correct case summaries for each assigned case. Performs timely administrative duties associated with investigations in conformity with applicable Medicaid Provider Integrity [MPI]-OIG policies and procedures (10%). 3. Conducts interviews with recipients, witnesses, providers, complainants and providerand#146;s staff regarding investigations (10%). 4. Develops witness lists and comprehensive exhibits to ensure effective case presentations in administrative hearing and court cases, when required (10%). 5. Effectively communicates findings to the Manager of Investigations, Director of MPI, other HHSC staff, and external entities. Provides testimony and presents evidence in formal hearings and court proceedings; develops and presents criminal fraud cases to criminal prosecutors, when appropriate (10%). 6. Makes consultative visits to the Attorney Generaland#146;s Medicaid Fraud Control Unit, the Antitrust and Civil Medicaid Fraud Division, other state and federal agencies, licensure boards, and other external entities to discuss and/or coordinate Medicaid provider fraud and abuse investigations; interpret program policies, standards, and procedures; conduct training workshops; participate in joint investigations, and provide advice and recommendations (5%). 7. Develops, recommends and implements solutions to problems. Reviews, develops and recommends guidelines, procedu Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.

Keywords: Texas State Job Bank, Grand Prairie , Investigator VII, Other , GRAND PRAIRIE, Texas

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