Medicaid Fraud Investigator

Summary

Financial Investigator I (NS)The primary purpose of these positions is to perform investigations in the area of criminal and civil Medicaid fraud schemes, patient abuse or neglect, and misappropriation of recipient funds by conducting and participating in a wide variety of case investigations involving financial analysis. Work requires knowledge of applicable state and Federal laws and regulations. Position manages investigative assignments and/or projects by:Conducting complex criminal and civil investigations involving Medicaid provider fraud and patient abuse and neglect.Data analysis of Medicaid claims.Reviewing financial documents, including bank statements, cancelled checks, corporate and individual income tax returns, etc.Reviewing medical records and service notes of Medicaid Recipients.Interviewing witnesses, including Medicaid Recipients, current and former employees, Medicaid Policy administrators, DHHS employees, DSS employees, etc.Interviewing individuals suspected of committing Medicaid provider fraud and patient abuse and neglect.Preparing detailed reports from the results of interviews conducted.Working with Federal, State and local law enforcement agencies, including AUSAs.Testifying in State and/or Federal court.Understanding of the Rules of Evidence in criminal investigations.Some travel, including some occasional overnight stays are required. The selected candidate is subject to a background investigation.Knowledge Skills and Abilities/Management Preferences:Law enforcement experienceHealthcare industry investigator or analyst experienceFamiliarity with healthcare terminology and policyAccounting and/or financial backgroundInterviewing and report writing experienceMinimum Education and Experience:Bachelor's degree in accounting, finance, business administration or criminal justice from an appropriately accredited institution, with eighteen credit hours of accounting coursework and two years of experience in auditing and/or investigating tax, financial, or securities crimes; or equivalent combination of education and experience.Necessary Special Requirements: May require certification as a Law Enforcement Officer or Special Agent in accordance with the provisions of the North Carolina Criminal Justice Training and Standards Commission or the ability to achieve certification within one year of employment.The State of North Carolina offers employer paid health insurance plus twelve paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at Employee Benefits.Resumes and cover letters: To receive credit for your work history and credentials, you must list the information on the online application form. This information is used to determine if you meet the requirements of the position, and if you are selected, it is used to determine a salary offer.Using the terms "See Resume" or "See Attachment" will not be accepted, and your application will be rejected as incomplete. Cover letters are highly encouraged but not required.Credit for foreign degrees will only be given if verification of degree certification is attached to your application. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine US equivalency.EEO Statement: The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.

Job Description

Financial Investigator I (NS)The primary purpose of these positions is to perform investigations in the area of criminal and civil Medicaid fraud schemes, patient abuse or neglect, and misappropriation of recipient funds by conducting and participating in a wide variety of case investigations involving financial analysis. Work requires knowledge of applicable state and Federal laws and regulations. Position manages investigative assignments and/or projects by:Conducting complex criminal and civil investigations involving Medicaid provider fraud and patient abuse and neglect.Data analysis of Medicaid claims.Reviewing financial documents, including bank statements, cancelled checks, corporate and individual income tax returns, etc.Reviewing medical records and service notes of Medicaid Recipients.Interviewing witnesses, including Medicaid Recipients, current and former employees, Medicaid Policy administrators, DHHS employees, DSS employees, etc.Interviewing individuals suspected of committing Medicaid provider fraud and patient abuse and neglect.Preparing detailed reports from the results of interviews conducted.Working with Federal, State and local law enforcement agencies, including AUSAs.Testifying in State and/or Federal court.Understanding of the Rules of Evidence in criminal investigations.Some travel, including some occasional overnight stays are required. The selected candidate is subject to a background investigation.Knowledge Skills and Abilities/Management Preferences:Law enforcement experienceHealthcare industry investigator or analyst experienceFamiliarity with healthcare terminology and policyAccounting and/or financial backgroundInterviewing and report writing experienceMinimum Education and Experience:Bachelor's degree in accounting, finance, business administration or criminal justice from an appropriately accredited institution, with eighteen credit hours of accounting coursework and two years of experience in auditing and/or investigating tax, financial, or securities crimes; or equivalent combination of education and experience.Necessary Special Requirements: May require certification as a Law Enforcement Officer or Special Agent in accordance with the provisions of the North Carolina Criminal Justice Training and Standards Commission or the ability to achieve certification within one year of employment.The State of North Carolina offers employer paid health insurance plus twelve paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at Employee Benefits.Resumes and cover letters: To receive credit for your work history and credentials, you must list the information on the online application form. This information is used to determine if you meet the requirements of the position, and if you are selected, it is used to determine a salary offer.Using the terms "See Resume" or "See Attachment" will not be accepted, and your application will be rejected as incomplete. Cover letters are highly encouraged but not required.Credit for foreign degrees will only be given if verification of degree certification is attached to your application. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine US equivalency.EEO Statement: The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.