Medicaid Program Integrity Provider Fraud Investigator

Medicaid Program Integrity Provider Fraud Investigator

The Department of Health and Human Services (DHHS), Medicaid and Long-Term Care Division, is looking for a strategic partner with a high personal standard of integrity and a keen eye for detail to join their team as the Medicaid Program Integrity Provider Fraud Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS. Under limited supervision, investigates suspected Medicaid provider fraud and program abuse by conducting investigations and audits; prepares and writes investigational reports; compiles prosecution materials and reports; coordinates investigations with Office of Inspector General, FBI and other appropriate law enforcement agencies; presents cases to prosecutors and provides expert testimony in all phases of criminal and civil prosecution and administrative actions; monitors, evaluates and enforces Medicaid providers compliance with conditions of participation and relevant rules, regulations and laws; performs related work as required. You have the passion; we have the opportunities let's make a difference for Nebraskans.

As the Medicaid Provider Fraud & Abuse Investigator, you will :

• Ensure safety of the Medicaid client and program by identifying, investigating, and intervening in provider fraud, waste, abuse, or erroneous payments.

Hire Rate : $25.043 per hour Non-Exempt

Work Schedule : Monday Friday; 8 : 00 AM 5 : 00 PM

Dress Attire : Business Casual

Driving required

Location : Nebraska State Office Building in Lincoln

Requirements / Qualifications :

Minimum Qualifications : Post high school coursework / training in law enforcement, criminal justice, social / behavioral sciences or health related field, nursing, business or public administration, management, program analysis or evaluation of data systems. OR Experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports and evaluating their use and effectiveness, policy planning / analysis, casework, nursing, accounting or billing systems.

Preferred Qualifications :

Other : Valid driver's license or the ability to provide independent authorized transportation.

Knowledge, Skills, and Abilities :

Knowledge of : Interview and interrogation techniques; fraud investigation and detection techniques and principles; methods and techniques of program planning.

Ability to : Communicate effectively, prepare objective, factual reports; maintain confidentiality; compile and evaluate data to formulate recommendations and interpret directives; read and understand rules, regulations, and guidelines and apply them to resolve problems; identify and extract pertinent information from records, conversations and observations; make decisions and take action in dealing with problems and situations; plan and organize work; establish and maintain positive relationships with agency staff, service providers and law enforcement agencies.