Senior Auditor - Medicaid Fraud Control Unit

DelDOT; New Castle (PA); Hybrid; USD 70,000 - 110,000; Full time

Benefits offered by this job

Healthcare plan

Pension plan

Vacation leave

Paid parental leave

Job summary

The Delaware Department of Justice is seeking an exceptional Senior Auditor to join the Medicaid Fraud Control Unit in the Fraud & Consumer Protection Division in the New Castle County office. The role focuses on providing auditing and data analysis expertise in health care fraud investigations and False Claims Act work.

You will work within a collaborative team, independently when needed, handling data mining, claims analysis, restitution calculations, and presenting findings.

Qualifications

• Bachelor’s degree or higher in Economics, Finance, Business, Computer Information Systems or related field.
• Three years of experience in designing analytical studies and data collection methods.
• Three years of experience interpreting laws, rules, regulations, standards, policies, and procedures.
• Strong planning, prioritizing, organizing, and problem solving skills.
• Ability to analyze data and make sound recommendations.
• Proficiency with data analysis software (Excel, Access, SAP BO, Tableau, Cognos, SAS, SPSS, SQL).
• Experience in collecting, analyzing, summarizing, and formatting large data sets.
• Experience in narrative report writing.

Responsibilities

• Manage the unit’s data mining program, including proposals, development, and ROI analysis.
• Perform database queries to extract claims and related data for investigations.
• Analyze varied healthcare and financial data to identify fraud signals.
• Identify trends in claims data and financial records to detect fraud.
• Prepare reports and present findings to an investigative team.
• Prepare trial exhibits and testify as needed.
• Coordinate with Medicaid agency and managed care orgs on policy and info requests.

Skills

Data analysis

Audit

Healthcare fraud

SQL

Excel

Statistics

Communicate findings

Education

Bachelor’s degree in Economics/Finance/CS

Tools

Excel

SQL

Tableau

SAS

Power BI

Job description

Introduction

Delaware's Attorney General, the State's chief law enforcement officer, has a broad responsibility to combat crime, uphold civil rights, safeguard families, fight fraud, and protect consumers in the First State.

In meeting this mission, Attorney General Kathy Jennings is supported by teams of talented lawyers and staff in the Criminal, Civil, Family, Fraud and Consumer Protection, and Civil Rights and Public Trust Divisions. Each of the more than 500 staff who work in the Office of the Attorney General are dedicated to serving all Delawareans with integrity and passion.

Deputy Attorneys General, with critical support from criminal special investigators, victim service specialists, paraprofessionals, and administrative staff, prosecute criminal cases, enforce consumer laws, provide counsel to state agencies, ensure the public's access to open government, protect the abused, and much more.

Summary Statement

The Delaware Department of Justice is seeking an exceptional and highly motivated individual to join the Medicaid Fraud Control Unit (MFCU) in the Fraud & Consumer Protection Division in the New Castle County office as a Senior Auditor. We seek an individual with a strong commitment to working in the public interest.

The Senior Auditor will be responsible for providing auditing and data analysis expertise in civil and criminal health care fraud investigations.

The civil cases pertain to health care fraud and cases brought under the Delaware False Claims and Reporting Act.

The criminal cases involve the prosecution of health care fraud, drug diversion, patient abuse and neglect, and financial exploitation.

In addition, the Senior Auditor will be assigned to multijurisdictional qui tam cases managed by the National Association of Medicaid Fraud Control Units.

The Senior Auditor will be a member of an investigative team responsible for compiling evidence of fraudulent activity throughout the Delaware Medicaid and Medical Assistance Program, and other State and Federal programs. There is considerable teamwork involved in identifying, investigating, and litigating health care fraud. The ability to work independently and collaboratively as a team member is essential.

Preferred skills include:

• Medicaid, Medicare, general healthcare industry practices, and/or medical billing and coding concepts;
• Knowledge of statistically valid random sampling;
• Knowledge of Generally Accepted Accounting Principles (GAAP);
• Knowledge of inferential statistics such as correlation, t-tests, f-tests, or analysis of variance; and
• Knowledge of descriptive statistics such as mean, median, mode, or standard deviation.

It is encouraged that applicants submit a writing sample demonstrating proficiency in data analysis and report writing, but not required.

This position may be eligible for telework for up to three days per week.

This position may close on or before the stated closing date upon filling the position.

Essential Functions

Specific duties for the position include but are not limited to the following:

• Managing the unit’s data mining program including project proposals, project development, data analysis, coordinating data mining efforts with the state Medicaid agency, and projecting and tracking program costs and return on investment;
• Performing database queries to extract claims records and other data to support investigations;
• Analyzing varied and complex health care and financial data;
• Detecting and developing trends and patterns in health care claims data and financial records to identify evidence of fraud;
• Researching laws, policy, and regulations to facilitate claims analysis;
• Summarizing data using tables, charts, graphs, and other visualization methods, where applicable;
• Identifying and calculating restitution and damage figures;
• Preparing written reports and presenting findings to an investigative team;
• Preparing trial exhibits and testifying, as needed;
• Making program and policy recommendations;
• Coordinating with the state Medicaid agency and Medicaid Managed Care Organizations regarding policy, referrals, contracts, and requests for information;
• Providing technical expertise to multijurisdictional teams regarding Medicaid claims, policy, databases and systems, and related information; and
• Other duties, as assigned.

Job Requirements

Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

• A Bachelor’s degree or higher in Economics, Finance, Business Management, Computer Information Systems or related field (equivalent work experience may be considered);
• Three years of experience in designing analytical studies, which includes determining study goals and objectives, information needed, data sources, and sampling and collection methods;
• Three years of experience in interpreting laws, rules, regulations, standards, policies, and procedures;
• Skill in planning, prioritizing, organizing, and problem solving;
• Ability to analyze data and make sound recommendations;
• Proficiency in the use of software for data analysis, such as: Microsoft Excel, Microsoft Access, SAP Business Objects, Tableau, Cognos, SAS, SPSS, SQL, or other data analytics/statistical software;
• Experience collecting, analyzing, summarizing, and formatting large data sets; and
• Experience in narrative report writing.

Additional Posting Information

This posting may close on or before the stated closing date upon filling the vacant position.

This position is exempt from the State of Delaware Merit System.

Conditions of Hire

Employment is contingent upon satisfactory background checks.

Direct deposit of paychecks is required as a condition of hire.

Applicants must be legally authorized to work in the United States.

Benefits

Department of Justice Benefits Include:

• May be eligible Loan forgiveness (State and Federal).
• State of Delaware healthcare plan.
• State of Delaware pension plan.
• Over 4 weeks of vacation per year.
• 3 weeks of paid sick leave per year.
• 12 weeks of paid parental leave.
• To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/

Accommodations

Accommodations are available for applicants with disabilities in all phases of the application and employment process. To request an auxiliary aid or service please call [phone]. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance.

The State of Delaware is an Equal Opportunity employer and values a diverse workforce.

We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.