Maintenance Investigator II

Food and Nutrition and Program Integrity experience preferred. NC Fast experience required.

The primary purpose of this position is to investigate and gather facts to determine if improper determination of eligibility for public assistance cases such as Medicaid, Food and Nutrition, WFFA, CIP and LIEAP have been implemented and/or if fraudulent practices have occurred. When an error indicates potential client fraud, the Income Maintenance Investigator is responsible for investigating the case and determining the appropriate course of action required to resolve the case referral.

The Income Maintenance Investigator must also evaluate suspected fraud cases for possible court action, prepare the case for court, represent the agency in court and interact with the judicial process. Responsibilities also include agency representation at administrative hearings, collections, and recoupments. This worker is a part of the Adult Medicaid unit and is supervised by the Adult Medicaid Long Term Care/Program Integrity Supervisor.

The regular working hours in this position are from 8:00 AM until 5:00 PM – Monday through Friday, except holidays. This Investigator may be called upon to work outside the scheduled business hours for any number of reasons, including being involved in a court case past the normal work hours or meeting with a client that comes into the building just before 5:00 p.m.

Fraud investigation procedures are becoming more sophisticated due to retinal imaging and other automated enhancements such as Tax Intercept, Food and Nutrition automatic deduction, EBT Edge, Medicaid Profiles, Lexis Nexis, NC FAST, EPICS and online verifications. It is anticipated that these changes and improvements will require additional training and staffing.

Investigation procedures include, but may not be limited to:

Gathering of facts from reliable sources such as agency staff, case records, employers, hospitals, post offices and other government agencies such as Department of Motor Vehicles, Social Security Administration, Employment Security Commission, Tax Departments, Registers of Deeds, Health Departments, USDA, Alien Registration office, Law Enforcement Agencies, lawyers, rental agencies, banks, collaterals and many other community resources. This information may be gathered by personal interviews, telephone, facsimile, news reports and/or newspapers, and social media.

If fraudulent acts have occurred, the fraud investigator is responsible for re‑constructing the case to determine the amount of over payment. The investigator must also determine if the case should be referred to the Human Services Board for approval of Investigator's recommendation - that may include court action. Active cases must be investigated timely in order to assure accurate ongoing assistance.

Assistance may be requested by the USDA to investigate retail abuse in the Food and Nutrition Services program.

Manage and complete twenty (20) FRR and BEER Reports weekly in ensuring information on file is reported accurately. Turn in number of reports worked weekly and completed to department supervisors. Investigate all cases for over payments, underpayments, complete fraud referrals and establish in NC FAST processing within required time frames of 180 days. Return reports to department supervisors for state/security compliance for the following programs upon completion.

• Adult Medicaid
• Family and Children’s Medicaid
• All other public assistance programs

Manage Quarterly Interstate Match Reports to ensure non‑dual participation across state lines for both Medicaid Programs and return to department supervisors timely. Create potential fraud referrals and manage in NC FAST and in‑house tracking timely.

Key all fraud referrals into NC FAST and in‑house tracking system timely.

Study, take all online courses in The Learning Gateway and learn all NC FAST procedures as Program Integrity is fully implemented into NC FAST.

Manage caseloads due to vacant districts and or shortage of staff due to short term or extended leave and serve as…