Auditor (Healthcare Fraud)

United States Attorneys' Offices; Phoenix (AZ); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Comprehensive benefits package

Telework opportunities

Job summary

The United States Attorneys' Offices in the District of Arizona seeks a Health Care Fraud Auditor to support the Affirmative Civil Enforcement unit. The role uses medical terminology, procedures, and reimbursement processes to audit health care programs for civil fraud investigations and litigation.

You will work on CMS/Tricare related matters and prepare precise audit documents. Ideal candidates have accounting/auditing experience, education in accounting, and familiarity with federal fraud

Qualifications

• Bachelor's degree in Accounting or related field with 24 semester hours in Accounting (+ up to 6 hours of Business Law)
• At least 4 years of accounting/auditing experience with professional accounting knowledge
• Certification (CPA/CIA) or equivalent education/experience may fulfill requirements for specialized work

Responsibilities

• Conduct audits and investigations to identify violations of federal law (False Claims Act, Anti-Kickback Statute, Stark Law)
• Analyze Medicare/Medicaid claims data and design data techniques to detect fraud using CMS databases
• Prepare concise audit reports, charts, summaries, and schedules with clear conclusions
• Investigate and determine net worth for settlements and judgments as part of civil enforcement

Skills

Audit procedures

Data analysis

Medical terminology

Education

Accounting degree + 24 hours in Accounting

CPA or CIA certificate

Tools

CMS databases

Job description

Summary

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

Summary

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

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-13033813-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.
• 3729-3733, 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, applicants must also possess the following:

GS-13: To be eligible at the GS-13 level, you must have at least one full year of specialized experience equivalent to the GS-12 level.

Specialized Experience is defined as experience conducting public financial accounting examination of books, journals, and other business records and electronic information, and restructuring partial or inadequate records from a wide variety of sources. Analyzing accounting data in complex financial investigations to identify suspected fraud in organizational dealings. Performing auditing and financial analysis requiring knowledge of corporate finance, such as public finance, securities, investments and banking. Reviewing, auditing, and analyzing the financial operations of a variety of complex commercial, industrial, financial and other large organizations by examining financial statements, accounting records, operating reports, billing records, invoices, data processing material, electronic automated systems, and other documents pertaining to the transactions, events or allegations under investigation.

Interagency Career Transition Assistance Plan (ICTAP)- The ICTAP provides eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. If your agency has notified you in writing that you are a displaced employee eligible for ICTAP consideration, you may receive selection priority if: 1) this vacancy is within your ICTAP eligibility; 2) you apply under the instructions in the announcement; and 3) you are found well-qualified for this vacancy. To be well-qualified, you must satisfy all qualification requirements for the vacant position and receive a score of 85 or better on established ranking criteria. You must provide proof of eligibility to receive selection priority. Such proof may include a copy of your written notification of ICTAP eligibility or a copy of your separation personnel action form. Additional information about ICTAP eligibility is at: http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.

Career Transition Assistance Plan (CTAP)-The CTAP provides eligible surplus and displaced competitive service employees in the Department of Justice with selection priority over other candidates for competitive service vacancies. If your Department of Justice component has notified you in writing that you are a surplus or displaced employee eligible for CTAP consideration, you may receive selection priority if: 1) this vacancy is within your CTAP eligibility, 2) you apply under the instructions in this announcement, and 3) you are found well-qualified for this vacancy. To be well qualified, you must satisfy all qualification requirements for the vacant position and receive a score of 85 or better on established ranking criteria. You must provide a copy of your written notification of CTAP eligibility with your application. Additional information about CTAP eligibility is at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.

Veterans Employment Opportunity Act (VEOA) -VEOA allows eligible veterans to apply and compete for positions announced under merit promotion procedures when the hiring agency is recruiting from outside its own workforce. To be eligible for a VEOA appointment, a veteran must be honorably separated and either a preference eligible or have substantially completed three (3) or more years of continuous active military service. If you are applying for a Merit Promotion announcement and wish to be considered under VEOA, you must submit a copy of the Member Copy 4 of your DD-214, in addition to any other required documents listed on this announcement.

Special Employment Consideration - Persons with disabilities, veterans with a compensable service-connected disability of 30% or more, certain other veterans, spouses of certain members of the armed forces, and returning Peace Corps volunteers are examples of individuals who are potentially eligible for non-competitive appointments. For further information, click on the links provided below . You must specify in your online questionnaire under what authority you wish to be considered and submit appropriate documentation to verify your eligibility.

Noncompetitive Appointment Authorities Links

https://www.opm.gov/policy-data-oversight/hiring-information/competitive-hiring/#url=Types-of-Appointments

Education

All academic degrees and coursework must be completed at a college or university that has obtained accreditation or pre-accreditation status from an accrediting body recognized by the U.S. Department of Education. For a list of schools that meet this criteria, see http://www.ed.gov

OR

Education completed in foreign colleges or universities may be used to meet the above education requirements if you can show that the foreign education is comparable to that received in an accredited educational institution in the United States. It is your responsibility to timely provide such evidence by submitting proof of creditability of education as evaluated by a credentialing agency with your application materials. More information may be found at http://www2.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html. All documentation must be in English or include an English translation.

Additional information

Payment of relocation expenses will not be authorized.

The Department of Justice offers a comprehensive benefits package that includes, in part, paid vacation; sick leave; holidays; telework; life insurance; health benefits; and participation in the Federal Employees Retirement System.

Selective Service: If you are a male applicant born after December 31, 1959, you must certify that you have registered with the Selective Service System, or are exempt from having to do so under the Selective Service Law. See http://www.sss.gov/.

Reasonable Accommodation Statement: Federal Agencies must provide reasonable accommodation to applicants with disabilities, where appropriate. Applicants requiring reasonable accommodation for any part of the application and hiring process should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.

EEO Statement/Policy: The United States government does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service or other non-merit factor. More information can be found here: https://www.justice.gov/jmd/media/1425556/dl?inline.

Political Appointees (Current or Former): The Office of Personnel Management (OPM) must authorize employment offers made to current or former political appointees. If you are currently, or have been within the last 5 years, a political Schedule A, Schedule C or Non-Career SES employee in the Executive Branch, you must disclose this information to the HR Office. Failure to disclose this information could result in disciplinary action including removal from Federal Service.

Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.

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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.