Medicaid Provider Fraud and Abuse Investigator
State of Nebraska

Job Info

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The work we do matters!

Hiring Agency:
Health & Human Services - Agency 25

Location:
Nebraska State Office Building - Lincoln

Hiring Rate:
$24.492

Job Posting:
JR2024-00007681 Medicaid Provider Fraud and Abuse Investigator (Open)

Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):

Job Description:
The Department of Health and Human Services (DHHS), Division of Medicaid & Long-Term Care is looking for a strategic partner for the position of Medicaid Fraud and Abuse Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS.

You have the passion, we have the opportunities - let's make a difference for Nebraskans!

Examples of Work

The Medicaid Provider Fraud and Abuse Investigator, under limited supervision:

• Investigates allegations of provider fraud, waste, abuse, or erroneous payment
• Completes data mining and other case finding activities
• Prepares and writes investigation reports
• Responsible for regular audits and projects
• Collaborates with law enforcement entities that criminally and civilly prosecute Medicaid fraud
• Evaluates provider compliance and intervenes to correct behavior
• Works as part of a team on projects
• Perform related work as required

Requirements/Qualifications

Minimum Qualifications: 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 and evaluating their use and effectiveness, policy planning/analysis, casework, nursing, accounting or billing systems.

Preferred Qualifications: Bachelors degree in criminal justice or related filed. Coding certification or significant experience with medical terminology, diagnosis, and procedure codes. Experience with investigations. Experience in interviewing people. Significant experience with data warehouses and decision support systems, Excel, and other information systems tools. Experience with Medicaid providers and covered services

Other: Valid driver's license or the ability to provide independent authorized transportation. Ability to travel as projects/initiatives dictate, and ability to work 8-5 core hours in addition to varied hours based on workload and project requirements

Knowledge, skills, abilities

Knowledge of state and federal law and Nebraska Medicaid covered services and program. Experience reviewing or documenting clinical records. Experience with NFOCUS and / or the Medicaid Management Information System (MMIS). Ability to handle conflict.


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.

Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits

Equal Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.

Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub - Internal Apply app from your home landing page.

This job has expired.