Medicaid Program Integrity Provider Fraud Investigator
About The Position
The Department of Health and Human Services (DHHS), Medicaid and Long-Term Care Division, is looking for a strategic partner with a high personal standard of integrity and a keen eye for detail to join their team as the Medicaid Program Integrity Provider Fraud Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS. Under limited supervision, investigates suspected Medicaid provider fraud and program abuse by conducting investigations and audits; prepares and writes investigational reports; compiles prosecution materials and reports; coordinates investigations with Office of Inspector General, FBI and other appropriate law enforcement agencies; presents cases to prosecutors and provides expert testimony in all phases of criminal and civil prosecution and administrative actions; monitors, evaluates and enforces Medicaid providers compliance with conditions of participation and relevant rules, regulations and laws; performs related work as required. "You have the passion; we have the opportunities - let's make a difference for Nebraskans" As the Medicaid Provider Fraud & Abuse Investigator, you will: Ensure safety of the Medicaid client and program by identifying, investigating, and intervening in provider fraud, waste, abuse, or erroneous payments. Hire Rate: $25.043 per hour - Non-Exempt Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM Dress Attire: Business Casual Driving required Location: Nebraska State Office Building in Lincoln
Requirements
- Post high school coursework/training in law enforcement, criminal justice, social/behavioral sciences or health related field, nursing, business or public administration, management, program analysis or evaluation of data systems.
- Experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports and evaluating their use and effectiveness, policy planning/analysis, casework, nursing, accounting or billing systems.
- Valid driver's license or the ability to provide independent authorized transportation.
Nice To Haves
- Post high school course work in criminal justice or a human services field
- Certified Professional Coder
- Knowledge of the services and providers enrolled in and reimbursed by Nebraska Medicaid
- Experience working with medical claims
- Experience working Investigations
Responsibilities
- Ensure safety of the Medicaid client and program by identifying, investigating, and intervening in provider fraud, waste, abuse, or erroneous payments.
Benefits
- We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life.
- Your paycheck is just part of your total compensation.
- For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Executive, Legislative, and Other General Government Support
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
