Medicaid Fraud Investigator

Justice; North Carolina; Sur place; USD 58 000 - 69 000; Plein temps

Avantages offerts par ce poste

Health insurance

12 paid holidays

Retirement benefits

Résumé du poste

The North Carolina Department of Justice seeks an experienced investigator to join the Medicaid Investigations Division in Raleigh, NC. The role focuses on complex Medicaid fraud and patient abuse investigations, requiring strong financial analysis and legal knowledge.

Travel is occasional, and candidates must pass a background check and, if applicable, certification requirements. You will work with state and federal partners to protect taxpayer funds and ensure access to healthcare services.

Qualifications

• Bachelor’s degree in accounting/finance/BA/criminal justice with eighteen accounting credits and two years of auditing or investigating tax, financial, or securities crimes.
• May require certification as a Law Enforcement Officer or Special Agent within one year of employment.
• Experience in Medicaid fraud investigations or healthcare settings is preferred.

Responsabilités

• Conduct complex criminal and civil investigations of Medicaid provider fraud and patient abuse/neglect.
• Perform data analysis of Medicaid claims and review financial documents.
• Review medical records and service notes; interview witnesses and staff.
• Prepare detailed investigative reports and testify in State or Federal court.

Connaissances

Law enforcement

Healthcare investigator

Healthcare terminology

Accounting background

Interviewing & reporting

Formation

Bachelor’s degree in accounting/finance/BA/criminal justice

Description du poste

About Us

The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the state, state agencies, and elected officials, and defends the rights of the people of North Carolina. The Department handles all state criminal appeals cases and assists district attorneys with complex criminal cases at their request. Additionally, the Department of Justice includes the North Carolina State Crime Lab, the North Carolina Justice Academy, and the Sheriffs’ and Criminal Justice Education and Training Standards Divisions.

Description of Work

Recruitment Range: $57,983 - $69,000 IMPORTANT NOTE: This posting closes at 11:59:59 PM the night BEFORE the End Date listed. 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 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. The Medicaid Investigations Division (MID) investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. MID works closely with district attorneys’ offices, US Attorneys’ offices, federal, state and local agencies across the State. The damages in a Medicaid fraud case can range from a few thousand dollars to tens of millions of dollars. MID’s enforcement actions protect and recover taxpayer funds and help ensure access to needed medical services for Medicaid enrollees.

Knowledge Skills and Abilities/Management Preferences

• Law enforcement experience
• Healthcare industry investigator or analyst experience
• Familiarity with healthcare terminology and policy
• Accounting and/or financial background
• Interviewing and report writing experience

Minimum Education and Experience

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 the Education and Experience Equivalency Guide for details. 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.

Benefits

• 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.

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.