Auditor; Healthcare Fraud

Position: Auditor (Healthcare Fraud)

Summary

For more information on the Department of Justice and the United States Attorneys' Offices, visit http://(Use the "Apply for this Job" box below)..

Summary

For more information on the Department of Justice and the United States Attorneys' Offices, visit http://.

As needed, additional positions may be filled using this announcement.

This position is also being announced to All U.S. Citizens and Nationals under 26-AZ--DE.

Duties

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The United States Attorney's Office (USAO) District of Arizona is seeking a Health Care Fraud Auditor to work within the Office's Affirmative Civil Enforcement (ACE) unit. The auditor uses knowledge of medical terminology, medical procedures and processes, and medical insurance (Federal/State/private) reimbursement procedures to perform audit activities related to the detection of health care fraud, waste, or abuse for civil fraud investigations and litigation by the ACE unit.

These complex investigations encompass government contractors, health care providers, grant recipients, and other recipients of federal monies, but primarily involve the Centers for Medicare & Medicaid (CMS) and Tri-Care.

Typical Work Assignments Will Include

• Conducting audits and investigations to identify violations of federal law (primarily the False Claims Act, 31 U.S.C.
• , the Anti-Kickback Statute, 42 U.S.C.
• 1320a-7b(b)(1)(A), and the Stark Law, 42 U.S.C.
• 1395nn(a)) involving health care fraud against the Government;
• Analyzing Medicare and Medicaid claims data (as well as, on occasion, data involving other, similar government programs) and designing data techniques to detect fraud using CMS databases;
• Researching a variety of informational resources to query, gather and analyze patient-level data related to the provision of and reimbursement for health care services;
• Conducting investigations to make net worth determinations regarding the ability of individuals and organizations to pay settlements and judgments; and
• Preparing concise and accurate audit reports, charts, summaries, and schedules that draw conclusions from your analysis and investigation.

Responsibilities will increase and assignments will become more complex as your training and experience progress.

Requirements

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Conditions of employment

• You must be a U.S. Citizen or National.
• Initial appointment is conditioned upon a satisfactory pre-employment adjudication. This includes fingerprint, credit and tax checks, and drug testing. Continued employment is subject to a favorable adjudication of a background investigation.
• You must be registered for Selective Service, if applicable.
• If selected, you may be required to complete a one year probationary period.
• Time-in-Grade:
  Federal employees must meet time-in-grade requirements within 30 days after the closing date of this announcement.
• You must meet all qualification and eligibility requirements within 30 days after the closing date of this announcement and before placement in the position.

Qualifications


Basic Requirements:


Degree: Accounting; or a degree in a related field such as Business Administration, Finance, or Public Administration that included or was supplemented by twenty-four (24) semester hours in Accounting. The 24 hours may include up to 6 hours of credit in Business Law. (The term "Accounting" means "Accounting and/or Auditing" in this standard. Similarly, "Accountant" should be interpreted, generally, as "Accountant and/or Auditor.")

OR

Combination of education and experience: At least 4 years of experience in accounting, or an equivalent combination of accounting experience, college-level education, and training that provided professional accounting knowledge. The applicant's background must also include ONE of the following:

Twenty-four (24) semester hours in Accounting or Auditing courses of appropriate type and quality. This can include up to 6 hours of Business Law;

OR

A certificate as a Certified Public Accountant or a Certified Internal Auditor, obtained through written examination;

OR

Completion of the requirements for a degree that included substantial coursework in Accounting or Auditing, e.g., 15 semester hours, but that does not fully satisfy the 24-semester-hour requirement of paragraph A, provided that (a) the applicant has successfully worked at the full-performance level in Accounting, Auditing, or a related field, e.g., Valuation Engineering or Financial Institution Examining; (b) a panel of at least two higher level professional Accountants or Auditors has determined that the applicant has demonstrated a good knowledge of accounting and of related and underlying fields that equals in breadth, depth, currency, and level of advancement that which is normally associated with successful completion of the 4-year course of study described in paragraph A;

and (c) except for literal nonconformance to the requirement of 24 semester hours in Accounting, the applicant's education, training, and experience fully meet the specified requirements.

In addition to meeting the basic requirements,…