Senior Auditor - Medicaid Fraud Control Unit

State of Delaware•Dover, DE

11d

About The Position

The Delaware Department of Justice is seeking a Senior Auditor for the Medicaid Fraud Control Unit (MFCU) in the Fraud & Consumer Protection Division, based in the New Castle County office. The role provides auditing and data analysis expertise for civil and criminal health care fraud investigations. Civil matters include health care fraud and cases brought under the Delaware False Claims and Reporting Act; criminal matters include health care fraud, drug diversion, patient abuse and neglect, and financial exploitation. The Senior Auditor may also work on multijurisdictional qui tam cases managed by the National Association of Medicaid Fraud Control Units. As part of an investigative team, the Senior Auditor compiles evidence of fraudulent activity involving the Delaware Medicaid and Medical Assistance Program and other state and federal programs. The position involves substantial teamwork and requires the ability to work independently as well as collaboratively. The position may be eligible for telework up to three days per week. Applicants are encouraged, but not required, to submit a writing sample demonstrating data analysis and report-writing proficiency.

Requirements

Bachelor’s degree or higher in Economics, Finance, Business Management, Computer Information Systems, or a related field; equivalent work experience may be considered.
Three years of experience designing analytical studies, including determining goals and objectives, information needs, data sources, and sampling and collection methods.
Three years of experience 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 with data-analysis software such as Microsoft Excel, Microsoft Access, SAP Business Objects, Tableau, Cognos, SAS, SPSS, SQL, or other data analytics or statistical software.
Experience collecting, analyzing, summarizing, and formatting large data sets.
Experience in narrative report writing.
Employment is contingent upon satisfactory background checks.
Must be legally authorized to work in the United States.
Direct deposit of paychecks is required as a condition of hire.

Nice To Haves

Knowledge of Medicaid, Medicare, general health care 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.
Knowledge of descriptive statistics, such as mean, median, mode, or standard deviation.
Applicants are encouraged to submit a writing sample demonstrating proficiency in data analysis and report writing; this is not required.

Responsibilities

Manage the unit’s data mining program, including project proposals and development, data analysis, coordination with the state Medicaid agency, and tracking program costs and return on investment.
Perform database queries to extract claims records and other data supporting investigations.
Analyze varied and complex health care and financial data.
Identify trends and patterns in health care claims data and financial records that may indicate fraud.
Research laws, policies, and regulations to facilitate claims analysis.
Summarize data using tables, charts, graphs, and other visualization methods where applicable.
Identify and calculate restitution and damages.
Prepare written reports and present findings to an investigative team.
Prepare trial exhibits and testify as needed.
Make program and policy recommendations.
Coordinate with the state Medicaid agency and Medicaid Managed Care Organizations on policy, referrals, contracts, and information requests.
Provide technical expertise to multijurisdictional teams on Medicaid claims, policy, databases and systems, and related information.
Perform other duties as assigned.