Investigator - Medicaid Fraud

Georgia Department of Revenue•Atlanta, GA

40d•$60,000•Onsite

About The Position

The Office of the Attorney General, Department of Law, is seeking an Investigator for the Medicaid Fraud Division. The mission of the Department of Law is to serve the citizens of the State of Georgia by providing legal representation of the highest quality to the agencies, officers and employees of state government and by honorably and vigorously carrying out the constitutional and statutory responsibilities of the Attorney General. The position will serve in the Investigations section of the Medicaid Fraud Division.

Requirements

Twelve months of fraud investigation or related experience.

Nice To Haves

POST-Certification
Completion of a Bachelor’s degree from an accredited four-year college or university with a major in Criminal Justice, Healthcare Administration, Accounting, Business and Finance.
Certified Fraud Examiner
Digital Forensics Experience
Law enforcement experience
Demonstrated analytical skills.
Requires State training and verification of course passing.

Responsibilities

Conduct health care fraud investigations.
Assist criminal justice personnel, including Analysts, Auditors, and Prosecutors, in conducting on-site health care fraud and patient abuse investigations.
Develop knowledge and skills for using computer software programs in unit investigations.
Maintain and apply professional knowledge of current trends and developments related to work unit assignments.
Respond to assignments and requests for assistance in health care fraud and patient abuse investigations in a timely manner.
Review documentation, conduct interviews, and gather intelligence information for health care fraud and patient abuse investigations.
Participate in the planning and gathering of information for investigations involving health care fraud and patient abuse.
Assist in executing on-site search warrants to obtain evidence of health care fraud and patient abuse.
Assist in the identification and seizure of health care fraud evidence during the execution of on-site search warrants.
May be issued firearms and/or less lethal equipment (e.g. pepper spray).
Assist in preparing charts, schedules, and presentations for the prosecution of health care fraud cases.
Follow appropriate laws, guidelines, and policies in maintaining the chain of custody for evidence.
Collect, review, and evaluate necessary documents to identify and investigate health care fraud and patient abuse, including medical records, health care providers' billing records, and other records.
Assist in developing databases to analyze appropriate medical data.
Enter data into databases and analyze the data for evidence.
Assist in conducting source and expenditure analyses and cash flow analyses of suspects in health care fraud investigations and patient abuse investigations.
Assist in searching public records, governmental databases, and commercial databases for evidence of health care fraud and patient abuse allegations.
Assist in identifying potential assets subject to seizure due to health care provider fraud.
Assist in organizing, analyzing, and processing items of evidence and other documentation for investigation and prosecutorial purposes in health care fraud and patient abuse investigations.
Utilize computers and appropriate software to conduct health care fraud and patient abuse investigations.
Demonstrate basic knowledge of computer software in creating databases, spreadsheets, graphs, and presentations.
Demonstrate appropriate computer skills to conduct health care fraud investigations.
Prepare appropriate reports in a timely, thorough, and accurate manner.
Prepare thorough and accurate reports documenting interviews of witnesses and suspects.
Prepare thorough and accurate reports documenting the execution of search warrants and the seizure of evidence.
Prepare thorough and accurate reports documenting the analyses of financial databases and conclusions.
Prepare thorough and accurate reports documenting public record and database searches and conclusions.
Prepare thorough and accurate case reports for all investigative activities.
Distribute copies of reports to the appropriate parties in a timely manner.
Present courtroom testimony utilizing proper courtroom demeanor and assist prosecutors in coordinating pre-trial activities.
Provide accurate testimony concerning health care fraud investigations and patient abuse investigations.
Demonstrate knowledge of court system operations and methods of presenting testimony.
Coordinate and prepare courtroom testimony with the appropriate prosecuting attorney.
Demonstrate skills to be a witness and/or evidence coordinator on behalf of the prosecuting attorneys to ensure that all evidence and witnesses are available for presentation.
Maintain supplies, reports, equipment, and relationships with other agencies according to established Unit requirements.
Maintain assigned equipment based on Department policy and standards.
Complete applicable reports in a timely manner.
Demonstrate skills that allow the development of relationships and liaisons with other agencies, departments, and the public.
Maintain professional knowledge of current trends and developments in the field and apply pertinent new knowledge to the performance of other responsibilities.
Participate in seminars and professional meetings when available and approved in advance.
Maintain professional knowledge by reading up-to-date articles, books, and periodicals.
Apply pertinent new knowledge to the performance of assigned responsibilities.
Interact with all levels of state and local government in a way that promotes respect, encourages cooperation, and contributes to excellent performance.
Treat all other state and local personnel fairly, giving preferential treatment to no one.
Communicate accurate information to all other state personnel in a professional and courteous manner that conveys a willingness to assist.
Accept direction and feedback from supervisors and follow through appropriately.
Accept responsibility for mistakes and take action to prevent similar occurrences.
Use appropriate established channels of communication.
Maintain relationships and liaisons with other agencies, departments, and the public according to Unit requirements.