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Texas Attorney General · 1 month ago

OAG - Healthcare Program Enforcement | Auditor IV-V | 26-0132

Healthcare Program Enforcement (302-056-1)300 W. 15th St

Full-time

Onsite

Senior Level

$6,916.67/mo - $6,916.67/mo

6+ years exp

The Texas Attorney General's Office is seeking an Auditor for the Healthcare Program Enforcement Division, responsible for auditing Medicaid fraud investigations. The role involves examining medical claims data, documenting audits, and ensuring compliance with state regulations.

GovernmentLaw EnforcementNon Profit

Responsibilities

Performs senior-level audits/criminal/civil investigations and examinations of alleged Medicaid and healthcare 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/civil investigative reports, opening memos, and closing memos in a professional, correct, and timely manner, consistent with HPED guidelines

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

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

Certified Fraud ExaminerAuditingData analysisManagement information systemsCompliance monitoringHealthcare insuranceSound judgmentCustomer serviceEffective communication

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

6 years of full-time experience working in the following (or closely related) fields: management information systems, data science, 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

Certified Fraud Examiner (CFE)

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 supervise the work of others

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%

2 additional years of full-time experience working in the following (or closely related) fields: management information systems, data science, 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