Dental Investigator

NC Office of State Human Resources; North Carolina; Hybrid; USD 10,000 - 60,000; Part time

Job summary

The NC Office of State Human Resources is seeking a Dental Investigator for a part-time temporary role. This position involves monitoring dental vendors for compliance while conducting fraud investigations. Candidates should possess a dental hygiene license in North Carolina and have auditing experience, complemented by strong analytical skills and effective communication.

Benefits

Health insurance coverage under HDHP

Qualifications

• Licensed to practice as a dental hygienist in NC.
• Experience interpreting rules and regulations for dental providers.
• Ability to establish effective working relationships.

Responsibilities

• Conduct dental fraud investigations and ensure compliance.
• Monitor provider compliance to prevent fraud, waste, and abuse.
• Analyze documents and interview witnesses for investigations.

Skills

Communication

Data analysis

Time management

Education

Bachelor’s degree in a relevant field

Job description

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Description Of Work

This is a temporary position and there are no leave or retirement benefits offered with this position. Temporary employees who work an annual average of 30 or more hours per week may be eligible for health insurance coverage under the High-Deductible Health Plan (HDHP). For more information on health benefits offered visit www.shpnc.org .

Description Of Work

This is a temporary position and there are no leave or retirement benefits offered with this position. Temporary employees who work an annual average of 30 or more hours per week may be eligible for health insurance coverage under the High-Deductible Health Plan (HDHP). For more information on health benefits offered visit www.shpnc.org .

NOTE: If you are a current NC State Government employee, you will be considered for a temporary assignment. However, Temporary Solutionscannot accommodate dual employment.

This part-time temporary position is located in Raleigh, NC - Wake County.

Telework Availability

We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services (DHHS) offers work from home options and variable work schedule flexibility for this position.

The Division of Health Benefits (DHB) requires temporary workers with an approved hybrid telework schedule to work onsite at their assigned duty station at least 4 working days per month. More information on this arrangement may be obtained at the time of the interview.

Hourly Rate: $28.00 to $32.00

(Hourly Rates are based on education, experience, equity, and budget)

Position Overview

This is a temporary position within North Carolina Department of Health and Human Services (DHHS), Division of Health Benefits (DHB), NC Medicaid, Office of Compliance and Program Integrity (OCPI). OCPI is responsible for the detection and prevention of fraud, waste and abuse (FWA) in the delivery and cost of provider services and ensuring providers and managed care entities are in compliance with Medicaid rules and regulations. Functions and responsibilities for OCPI include compliance oversight of Medicaid health plans and contracted state vendors who conduct investigations of Medicaid FWA.

Job Specific Responsibilities

• Monitor dental provider compliance and contracted state vendors program integrity accountability to prevent fraud, waste and abuse (FWA).
• Conduct dental fraud, waste & abuse (FWA) investigations
• Ensure compliance with contracts through quality assurance reviews and monthly reporting.
• Provide compliance oversight and quality control of vendor FWA dental investigations
• Conduct investigations via analyzing documents and evidence, interviewing witnesses and summarizing findings in written reports.
• Perform other duties as assigned.
  
  

Knowledge, Skills And Abilities / Competencies

To receive credit for all your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all the following:

• Licensed to practice as a dental hygienist in the State of North Carolina
• Experience interpreting and applying rules, regulations, standards and policies regarding dental providers
• Ability to establish and maintain effective working relationships with the public and department staff
• Previous experience researching, collecting and analyzing data and information
• Excellent verbal and written communication skills
• Ability to work independently with minimum supervision
• Excellent time management and organizational skills
  
  

Management Preferences

• Program Integrity experience
• Investigations experience
• Experience working in a federally funded healthcare program
  
  

Minimum Education And Experience Requirements

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See oshr.nc.gov/experience-guide for details.

Bachelor’s degree in a discipline relative to the program area from an appropriately accredited institution and four years of related experience; or an equivalent combination of education and experience.

Supplemental and Contact Information

Supplemental And Contact Information

The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state, and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and support for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget of over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.

Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment. Pre-Employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).

Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. For technical issues with your application, please call the NeoGov Help Line at 855-524-5627.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Part-time

Job function

• Job function

  Other, Information Technology, and Management

• Industries

  Government Administration

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