OAG - Medicaid Fraud Control Unit | Auditor III-IV | 24-0447 - Capps : Job Details

Job DescriptionREVISED 08/28/2024GENERAL DESCRIPTION The Medicaid Fraud Control Unit (MFCU) Division of the Office of the Attorney General (OAG) is seeking an Auditor that performs financial investigative work. Work involves planning, organizing, and conducting advanced investigations and preparing reports on findings and recommendations. May lead an investigative team. Works under limited to minimal supervision with considerable to extensive latitude for the use of initiative and independent judgment. The OAG is a dynamic state agency with over 4,000 employees throughout the State of Texas. As the State's law firm, the OAG provides exemplary legal representation in diverse areas of law. OAG employees enjoy excellent benefits ( along with tremendous opportunities to do important work at a large, dynamic state agency making a positive difference in the lives of Texans. ESSENTIAL POSITION FUNCTIONS Auditor III:

• Conducts highly complex or assists with advanced audits/criminal investigations and examinations of alleged Medicaid provider fraud
• Queries, examines and analyzes Medicaid claims data to contribute to an efficient, team-oriented investigation; applies statistical sampling techniques to claims data as necessary; obtains information and data from a variety of systems to contribute to investigations; and collects and analyzes case evidence, including business records, financial records, banking records, and medical records
• Documents audits/investigations by preparing detailed audit/criminal investigative reports, opening memos, and closing memos in a professional, correct and timely manner, consistent with MFCU guidelines
• Assists with outreach presentations to outside agencies, associations, or groups, whose assistance and cooperation can enhance the mission of MFCU
• Represents the Office of the Attorney General by testifying before state and federal grand juries, in court settings, and at administrative hearings
• Performs related work as assigned
• Maintains relevant knowledge necessary to perform essential job functions
• Attends work regularly in compliance with agreed-upon work schedule
• Ensures security and confidentiality of sensitive and/or protected information
• Complies with all agency policies and procedures, including those pertaining to ethics and integrity

Auditor IV: All of the above functions for an Auditor III, PLUS:

• Conducts advanced (senior-level) audits/criminal investigations and examinations of alleged Medicaid provider fraud, including the development of audit/investigation objectives and plans; identifies violations of state law, federal law and Medicaid rules and regulations by Medicaid providers and their employees and obtains evidence to support these violations, including via witness and subject interviews; identifies the corresponding Medicaid overpayments associated with these violations

Qualifications:MINIMUM QUALIFICATIONS Auditor III:

• Education: Graduation from high school or equivalent
• Education: Bachelor's degree from an accredited college or university; experience in the following (or closely related) fields may be substituted for the required education on a year-for-year basis: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid or Medicare
• Experience: Four years of full-time experience working in the following (or closely related) fields: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid or Medicare; may substitute a master's degree from an accredited college or university for two years of the required experience
• Knowledge of word processing and electronic spreadsheet applications
• Skill in handling multiple tasks, prioritizing, and meeting deadlines
• Skill in effective oral and written communication
• Skill in exercising sound judgment and effective decision making
• Ability to receive and respond positively to constructive feedback
• Ability to work cooperatively with others in a professional office environment
• Ability to provide excellent customer service
• Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave)
• Ability to arrange for personal transportation for business-related travel
• Ability to work more than 40 hours as needed and in compliance with the FLSA
• Ability to lift and relocate 30 lbs.
• Ability to travel (including overnight travel) up to 20%

Auditor IV - All of the above qualifications for an Auditor III, PLUS:

• Experience: Two additional years' full-time experience in accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid or Medicare or closely related field; may substitute a master's degree from an accredited college or university for two years of the required experience
• Ability to speak before a variety of audiences in varied settings or formats

TO APPLY To apply for a job with the OAG, electronic applications can be submitted through either CAPPS Recruit or Work in Texas. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code. Military Crosswalk information can be accessed at: THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER