Senior Auditor - Medicaid Fraud Control Unit

Introduction

Delaware's Attorney General, the State's chief\r\nlaw enforcement officer, has a broad responsibility to combat crime, uphold\r\ncivil rights, safeguard families, fight fraud, and protect consumers in the\r\nFirst State.\r\n�\r\nIn meeting this mission, Attorney General\r\nKathy Jennings is supported by teams of talented lawyers and staff in the\r\nCriminal, Civil, Family, Fraud and Consumer Protection, and Civil Rights and\r\nPublic Trust Divisions. Each of the more than 500 staff who work in the Office\r\nof the Attorney General are dedicated to serving all Delawareans with integrity\r\nand passion.\r\n�\r\nDeputy Attorneys General, with critical\r\nsupport from criminal special investigators, victim service specialists,\r\nparaprofessionals, and administrative staff, prosecute criminal cases, enforce\r\nconsumer laws, provide counsel to state agencies, ensure the public's access to\r\nopen government, protect the abused, and much more.�\r\n

Summary Statement

The Delaware Department of\r\nJustice is seeking an exceptional and highly motivated individual to join the\r\nMedicaid Fraud Control Unit (MFCU) in the Fraud & Consumer Protection\r\nDivision in the New Castle County office as a Senior Auditor.� We seek an individual with a strong\r\ncommitment to working in the public interest.\r\n�\r\nThe Senior Auditor will be\r\nresponsible for providing auditing and data analysis expertise in civil and\r\ncriminal health care fraud investigations.\r\nThe civil cases pertain to health care fraud and cases brought under the\r\nDelaware False Claims and Reporting Act.\r\nThe criminal cases involve the prosecution of health care fraud, drug\r\ndiversion, patient abuse and neglect, and financial exploitation.� In addition, the Senior Auditor will be\r\nassigned to multijurisdictional qui tam cases managed by the National\r\nAssociation of Medicaid Fraud Control Units.\r\n\r\n�\r\nThe Senior Auditor will be a\r\nmember of an investigative team responsible for compiling evidence of\r\nfraudulent activity throughout the Delaware Medicaid and Medical Assistance\r\nProgram, and other State and Federal programs. �There is considerable teamwork involved in\r\nidentifying, investigating, and litigating health care fraud.� The ability to work independently and\r\ncollaboratively as a team member is essential.\r\n�\r\nPreferred skills include:\r\n\r\n�\r\nMedicaid, Medicare, general\r\nhealthcare industry practices, and/or medical billing and coding concepts;\r\n�\r\nKnowledge of statistically\r\nvalid random sampling;\r\n�\r\nKnowledge of Generally Accepted\r\nAccounting Principles (GAAP);\r\n�\r\nKnowledge of inferential\r\nstatistics such as correlation, t-tests, f-tests, or analysis of variance; and\r\n�\r\nKnowledge of descriptive\r\nstatistics such as mean, median, mode, or standard deviation.\r\n\r\n\r\nIt is encouraged that\r\napplicants submit a writing sample demonstrating proficiency in data analysis\r\nand report writing, but not required.\r\n\r\n\r\nThis position may close on or before the stated closing date upon filling the position.\r\n\r\n\r\n*****This position may be eligible for telework for up to three days per week.******\r\n

Essential Functions

Specific duties for the\r\nposition include but are not limited to the following: \r\n\r\n�\r\nManaging the unit’s data mining\r\nprogram including project proposals, project development, data analysis,\r\ncoordinating data mining efforts with the state Medicaid agency, and projecting\r\nand tracking program costs and return on investment; \r\n�\r\nPerforming database queries to\r\nextract claims records and other data to support investigations; \r\n�\r\nAnalyzing varied and complex\r\nhealth care and financial data;\r\n�\r\nDetecting and developing trends\r\nand patterns in health care claims data and financial records to identify\r\nevidence of fraud;\r\n�\r\nResearching laws, policy, and\r\nregulations to facilitate claims analysis;\r\n�\r\nSummarizing data using tables,\r\ncharts, graphs, and other visualization methods, where applicable;\r\n�\r\nIdentifying and calculating\r\nrestitution and damage figures;\r\n�\r\nPreparing written reports and\r\npresenting findings to an investigative team;\r\n�\r\nPreparing trial exhibits and\r\ntestifying, as needed;\r\n�\r\nMaking program and policy\r\nrecommendations; \r\n�\r\nCoordinating with the state\r\nMedicaid agency and Medicaid Managed Care Organizations regarding policy,\r\nreferrals, contracts, and requests for information;\r\n�\r\nProviding technical expertise\r\nto multijurisdictional teams regarding Medicaid claims, policy, databases and\r\nsystems, and related information; and\r\n�\r\nOther duties, as assigned.�\r\n\r\n

Job Requirements

Applicants must have education,\r\ntraining and/or experience demonstrating competence in each of the following\r\nareas:�\r\n\r\n�\r\nA Bachelor’s degree or higher\r\nin Economics, Finance, Business Management, Computer Information Systems or\r\nrelated field (equivalent work experience may be considered);\r\n�\r\nThree years of experience in designing analytical studies, which\r\nincludes determining study goals and objectives, information needed, data\r\nsources, and sampling and collection methods;\r\n�\r\nThree years of experience in interpreting laws, rules,\r\nregulations, standards, policies, and procedures;\r\n�\r\nSkill in planning, prioritizing, organizing, and problem solving;\r\n�\r\nAbility to analyze data and make sound recommendations;\r\n�\r\nProficiency in the use of software for data analysis, such as:\r\nMicrosoft Excel, Microsoft Access, SAP Business Objects, Tableau, Cognos, SAS,\r\nSPSS, SQL, or other data analytics/statistical software.\r\n�\r\nExperience collecting, analyzing, summarizing, and formatting\r\nlarge data sets; and \r\n�\r\nExperience in narrative report writing.\r\n\r\n

Additional Posting Information

�\r\nThis posting may close on or\r\nbefore the stated closing date upon filling the vacant position.\r\n�\r\nPlease be sure to upload a\r\nrecent copy of your resume, as you complete the application process for this\r\nposting.\r\n�\r\nThis position is exempt from\r\nthe State of Delaware Merit System.�\r\n

Conditions of Hire

�\r\nEmployment is contingent upon\r\nsatisfactory background checks.\r\n�\r\nDirect deposit of paychecks is\r\nrequired as a condition of hire.\r\n\r\n\r\n�\r\nApplicants must be legally\r\nauthorized to work in the United States.\r\n

Benefits

Department\r\nof Justice Benefits Include:\r\n�\r\nMay be eligible Loan\r\nforgiveness (State and Federal).\r\n�\r\nState of Delaware healthcare\r\nplan.\r\n�\r\nState of Delaware pension plan.\r\n�\r\nOver 4 weeks of vacation per\r\nyear.\r\n�\r\n3 weeks of paid sick leave per\r\nyear.\r\n�\r\n12 weeks of paid parental leave.\r\nTo\r\nlearn more about the comprehensive benefit package please visit our website\r\nat https://dhr.delaware.gov/benefits/\r\n

Accommodations

Accommodations\r\nare available for applicants with disabilities in all phases of the application\r\nand employment process.� To request an auxiliary aid or service please\r\ncall (302) 739-5458. TDD users should call the Delaware Relay Service Number\r\n1-800-232-5460 for assistance.\r\n�\r\nThe\r\nState of Delaware is an Equal Opportunity employer and values a diverse\r\nworkforce. We strongly encourage and seek out a workforce representative of\r\nDelaware including race, color, religion, age, sex, national origin, disability\r\nstatus, genetics, protected veteran status, sexual orientation, gender identity\r\nor expression.\r\n