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Fraud Investigative Analyst (13-0329)
WORK IN TEXAS JOB MATCH: Occupational Category: Protective Service; Occupation: Criminal Investigators & Special Agents; Industry: Public Administration. A State of Texas application in WorkInTexas must be completed to be considered for employment. Application for employment with the Office of the Attorney General may subject the selected candidate to a criminal background check. 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 JOB FUNCTIONS Obtains and analyzes information, data, and evidence from a variety of sources associated with cases and complaints of alleged Medicaid provider fraud and fraud in the administration of the Medicaid program; serves as a member of a multi-state, multi-agency investigative team as needed Identifies violations of state law, federal law and Medicaid rules and regulations associated with cases and complaints of alleged Medicaid fraud and obtains evidence to support prosecution and litigation of these violations Makes recommendations on the disposition of complaints and referrals received by the unit by preparing detailed written reports in a professional, correct and timely manner, consistent with MFCU guidelines Serves as a liaison with other state and federal agencies and organizations Advises and trains MFCU and CMFD staff on elements of the Texas Medicaid Program to enable them to more effectively investigate, prosecute and litigate allegations of Medicaid fraud; serves as a Medicaid program subject matter expert for MFCU and CMFD Receives and acts upon phone complaints from referring agencies and the general public Works overtime as needed Provides excellent customer service Uses personal vehicle for business-related travel Attends work regularly in accordance with agency leave policy Complies with all agency policies and procedures, including but not limited to applicable security and safety rules, regulations and standards MARGINAL JOB FUNCTIONS Performs related work as assigned MINIMUM QUALIFICATIONS Graduation from high school or equivalent Graduation from an accredited four-year college or university; may substitute full-time researching and compiling data, data extraction/query and analysis, using decision support software, statistical methods or relational databases to analyze data sets; Medicaid, Medicare, or healthcare insurance program integrity; white-collar crime investigations; or closely related experience for the required education on a year-for-year basis Four years full-time experience researching and compiling data, data extraction/query and analysis, using decision support software, statistical methods or relational databases to analyze data sets; Medicaid, Medicare, or healthcare insurance program integrity; white-collar crime investigations; or closely related experience; may substitute a masters degree from an accredited college or university in a related field for two years of the required experience Skill in researching and interpreting complex rules and regulations Skill in learning new or changing computer systems and databases Skill in writing and producing concise, professional quality documents and reports Skill in establishing and maintaining effective working relationship with management and co-worke