Investigative Specialist Medicaid

duties description

the division of medicaid investigations ensures the integrity of the medicaid program by conducting investigations, recovering over payments, and implementing administrative sanctions against providers. The official workstation of this position will be new york city. However, will have responsibility for supervising staff in regional offices and for oversight of investigative operations that may span statewide.

the division of medicaid investigations ensures the integrity of the medicaid program by conducting investigations, recovering over payments, and implementing administrative sanctions against providers. The official workstation of this position will be new york city. However, will have responsibility for supervising staff in regional offices and for oversight of investigative operations that may span statewide.

the incumbent will be responsible for the supervision of investigative units which are tasked to review, detect, and resolve issues of complex fraud or abuse issues. Investigations are accomplished using data mining, review of medical records, interviewing, financial audits and undercover activities, participation in joint investigations with other city, state, and federal agencies.

specific duties of the position include but are not limited to:

• supervising investigative staff in the downstate regional offices.
• evaluating complaints of medicaid fraud, waste, and abuse and assigning complaints for investigation.
• conducting regular case reviews for all staff to ensure progress meets investigative metrics and appropriate actions are taken.
• working a personal caseload including complex investigations.
• drafting correspondence, reports, and notices for public issuance in connection with administrative actions seeking to recoup medicaid over payments and impose sanctions.
• maintaining working relationships with the special investigative units within managed care organizations to discuss fraud trends and matters referred to omig.
• testifying at administrative hearings as necessary.
• ensuring recoupment of over payments and/or sanctions where appropriate.
• completing and reviewing staff performance evaluations.

two years of permanent service as an investigative specialist 2 (medicaid).

or

nine years of experience in conducting field investigations preliminary to administrative actions, civil litigation, or criminal prosecution. This experience must include conducting interviews of witnesses and others; taking written statements and affidavits; collecting and analyzing physical and documentary evidence; preparing detailed written reports of investigative findings; and testifying in court or at formal hearings. Two years of the experience must have been at a supervisory level.

non-qualifying investigative experience includes but may not be limited to: experience in routine police patrol work, security guard or related security position, tax collector, collector of delinquent accounts, credit checker, legal assistant/attorney, hotel or store detective, loss prevention officer, parole officer, correction officer, guard, inspector, or experience in adoption and/or foster care placement.

substitutions: an associate degree in criminal justice or related field may substitute for two years of qualifying experience. A bachelor’s degree in criminal justice or a related field may substitute for four years of qualifying experience. Related fields include: law enforcement, police science, criminal justice administration, criminology, criminal investigation, police studies, public justice, forensic accounting, forensic psychology, forensic science, and economic crime management.

excellent with verbal and written communication skills. Proficiency with microsoft office suite with the ability to learn new data systems.

non-competitive, permanent, full-time. There will be minimal mandatory overtime. New to state starting salary is $111,708 with a downstate adjustment of $4,150. The salary is non-negotiable.

routine travel is required throughout new york state to supervise staff and conduct fieldwork necessary to complete investigations. Must have a valid driver’s license or otherwise demonstrate the ability to meet the transportation requirements of the position.

telecommuting will be at a minimum for the first six months.

please be aware that because of the nature of the position, an appointment is subject to satisfactory…