Medicaid Fraud Investigator

North Carolina Judicial Branch; North Carolina; On-site; USD 58,000 - 69,000; Full time

Benefits offered by this job

Health insurance

Twelve paid holidays

Vacation and sick leave

Job summary

North Carolina Department of Justice seeks a Financial Investigator I (NS) to lead investigations into criminal and civil Medicaid fraud schemes, patient abuse, and misappropriation of funds. The role involves financial analysis, reviewing documents, and preparing comprehensive reports for Federal, State, and local agencies.

The position requires a bachelor’s degree with accounting coursework and two years of related experience; certifications may be required within one year.

Qualifications

• Law enforcement experience required.
• Healthcare terminology and policy familiarity.
• Accounting or financial background preferred.
• Interviewing and report writing experience.
• Bachelor’s degree plus accounting coursework and related experience required.

Responsibilities

• Conduct complex criminal and civil investigations involving Medicaid provider fraud and patient abuse/neglect.
• Perform data analysis of Medicaid claims.
• Review financial documents including bank statements and tax returns.
• Review medical records and service notes of Medicaid recipients.
• Interview witnesses and healthcare personnel; prepare detailed reports.

Skills

Law enforcement experience

Healthcare industry investigator or分析

Familiarity with healthcare wording

Accounting and/ or financial背景

Interviewing and report writing

Education

Bachelor’s degree in accounting, finance, business administration or criminal justice

Job description

Agency

Dept of Justice

Division

DOJ Legal Services

Job Classification Title

Financial Investigator I (NS)

Position Number

60010403

Grade

NC16

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.

The North Carolina 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.

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.

Supplemental Information:

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.