Apply on Employer Site

Texas Attorney General · 3 months ago

OAG - Medicaid Fraud Control Unit | Auditor III - IV | 26-0050

Texas-Grand PrairieWork Locations

Full-time

Onsite

Mid, Senior Level

$6,006.67/mo - $6,006.67/mo

4+ years exp

The Texas Attorney General's Office is a dynamic state agency seeking an Auditor III - IV for their Medicaid Fraud Control Unit. The role involves conducting complex financial investigations related to Medicaid provider fraud and preparing detailed reports on findings and recommendations.

GovernmentLaw EnforcementNon Profit

Responsibilities

Conducts highly complex or assists with advanced audits/criminal investigations and examinations of alleged Medicaid provider fraud

Queries, examines and analyzes Medicaid claims data to contribute to an efficient, team-oriented investigation; applies statistical sampling techniques to claims data as necessary; obtains information and data from a variety of systems to contribute to investigations; and collects and analyzes case evidence, including business records, financial records, banking records, and medical records

Documents audits/investigations by preparing detailed audit/criminal investigative reports, opening memos, and closing memos in a professional, correct and timely manner, consistent with MFCU guidelines

Assists with outreach presentations to outside agencies, associations, or groups, whose assistance and cooperation can enhance the mission of MFCU

Represents the Office of the Attorney General by testifying before state and federal grand juries, in court settings, and at administrative hearings

Conducts advanced (senior-level) audits/criminal investigations and examinations of alleged Medicaid provider fraud, including the development of audit/investigation objectives and plans; identifies violations of state law, federal law and Medicaid rules and regulations by Medicaid providers and their employees and obtains evidence to support these violations, including via witness and subject interviews; identifies the corresponding Medicaid overpayments associated with these violations

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

Complies with all agency policies and procedures, including those pertaining to ethics and integrity

Qualification

AccountingAuditingCompliance MonitoringMedicaid ExperienceHealthcare InsuranceSound JudgmentCustomer ServicePrioritization SkillsEffective CommunicationTeam CollaborationFeedback Reception

Required

Graduation from high school or equivalent

Bachelor's degree from an accredited college or university; experience in the following (or closely related) fields may be substituted for the required education on a year-for-year basis: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid or Medicare

Four years of full-time experience working in the following (or closely related) fields: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid or Medicare; may substitute a master's degree from an accredited college or university for two years of the required experience

Knowledge of word processing and electronic spreadsheet applications

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 work space 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 20%

Two additional years' full-time experience in accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid or Medicare or closely related field; may substitute a master's degree from an accredited college or university for two years of the required experience

Ability to speak before a variety of audiences in varied settings or formats