OAG - Medicaid Fraud Control Unit | Auditor III - IV

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

The Medicaid Fraud Control Unit division of the Office of the Attorney General is seeking an auditor whose work will involve financial investigative work. Work involves planning, organizing, and conducting advanced investigations and preparing reports on findings and recommendations. May lead an investigative team.

The OAG is a dynamic state agency with over 4,000 employees throughout the State of Texas. As the State’s law firm, the OAG provides exemplary legal representation in diverse areas of law. OAG employees enjoy excellent benefits (Benefits at a Glance) along with tremendous opportunities to do important work at a large, dynamic state agency making a positive difference in the lives of Texans.

• 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 over payments 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.

• Education:
  
  Graduation from high school or equivalent.
• Education:
  
  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.
• Experience:
  
  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)…