Lead Medicaid Fraud Investigator – Healthcare Compliance

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GENERAL DESCRIPTION The Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General (OAG) is seeking a Sergeant whose work will involve criminal investigations of Medicaid provider fraud and nursing home related investigations. Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. OAG employees enjoy excellent benefits along with tremendous opportunities to do important work and make a positive difference in the lives of all Texans.

JOB POSTING NOTICE Applicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check. The MFCU works cases jointly with other law enforcement agencies including the FBI, U.S. Department of Health and Human Services - Inspector General and IRS. In certain cases, it is necessary for our staff to have a Top Secret security clearance in order to fully participate in joint investigations or in task force activities.

Top Secret clearances are not required prior to employment but in certain cases may be required at a later date. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment.

ESSENTIAL POSITION FUNCTIONS Conducts complex criminal investigations of Medicaid provider fraud, and/or assures that nursing home related investigations are addressed professionally and in a timely manner, utilizing a wide range of techniques, with the goal of accomplishing the primary mission of MFCU, bringing violators of state and federal law, over which MFCU has jurisdiction, to justice, and identifying Medicaid and Medicaid related over payments to Medicaid providers

Plans, participates in and conducts undercover investigations, surveillance operations, raids, and searches; identifies, gathers, and examines evidence, including complex records of Medicaid providers; executes court orders, warrants, and subpoenas; and reports investigative findings

Establishes and maintains liaison with outside agencies, associations, groups, and the like whose assistance and cooperation can enhance the mission of MFCU, including but not limited to proactive generation of investigative targets; participates willingly in team investigative endeavors (intra-Team, inter-Team, inter-city, and inter-agency); and contributes to a positive work environment and high morale

May train, lead, and/or assist with the work of others.

Performs related work as assigned

Responds to emergency situations by serving on-call twenty-four hours per day/seven days per week

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

Qualifications:

MINIMUM QUALIFICATIONS

Education:

Graduation from high school or equivalent

Education:

Sixty credit hours from an accredited college or university; may substitute an associate and#8217;s or bachelor and#8217;s degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis

Experience:

Four years full time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer

TCOLE certification

Knowledge of TCOLE training requirements and healthcare fraud investigation training needs

Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook)

Knowledge of criminal investigative principles, techniques, and methodologies

Knowledge of management…