Provider Fraud Investigator

Hiring Agency: Health & Human Services - Agency 25

Location: Lincoln, NE

About the role

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 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.

As the Provider Fraud Investigator, you will protect the Medicaid Program and its clients by verifying that services are appropriately delivered and reimbursed by qualified professionals.

Responsibilities

• Investigate suspected Medicaid provider fraud and program abuse by conducting investigations and audits.
• Prepare and write investigational reports; compile prosecution materials and reports.
• Coordinate investigations with Office of Inspector General, FBI, and other appropriate law enforcement agencies.
• Present cases to prosecutors and provide expert testimony in all phases of criminal and civil prosecution and administrative actions.
• Monitor, evaluate, and enforce Medicaid providers' compliance with conditions of participation and relevant rules, regulations, and laws.
• Perform related work as required.

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.
• OR experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports, 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.

Preferred Qualifications

• Bachelor’s degree in Criminal Justice, Law, Social Work, Investigative Methods, or commensurate experience.
• Previous experience working with medical claims payment and adjudication, performing financial auditing of public accounts or medical facilities.

Skills

Knowledge of:

• Interview and interrogation techniques.
• Fraud investigation and detection techniques and principles.
• Methods and techniques of program planning.

Ability to:

• Communicate effectively and prepare objective, factual reports.
• Maintain confidentiality.
• Compile and evaluate data to formulate recommendations and interpret directives.
• Read and understand rules, regulations, and guidelines and apply them to resolve problems.
• Identify and extract pertinent information from records, conversations, and observations.
• Make decisions and take action in dealing with problems and situations.
• Plan and organize work.
• Establish and maintain positive relationships with agency staff, service providers, and law enforcement agencies.

Pay

$25.606 per hour – non-exempt

Schedule

• Monday – Friday; 8:00 AM – 5:00 PM
• Dress attire: Business Casual
• Driving required

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. Benefit eligibility may vary by position, agency, and employment status.

For more information on benefits, please visit: State of Nebraska Benefits.