Management Analyst IV

The Management Analyst IV performs highly advanced (senior-level) research, data reporting and analysis, and investigative work for the Chief Counsel Division of the Texas Health and Human Services Office of Inspector General.

The Management Analyst IV will work with attorneys, legal assistants, and other staff on complex cases involving fraud, waste, and abuse in the Medicaid system as well as other health and human services programs.

The work involves reviewing, researching, analyzing, and evaluating investigative findings; developing database queries and reports; reviewing medical and dental claims records; and presenting information orally and in writing.

May serve as team lead over other support staff and assist Chief Counsel leadership on various administrative matters. May train support staff and attorneys.

Duties and responsibilities primarily involve work falling under the purview and direction of the Deputy Inspector General for Complex Litigation.

Works under the supervision of the Chief Counsel Office Manager, with extensive latitude for the use of initiative and independent judgment.

Essential Job Functions:

Researches, collects, queries, and analyzes data using standard database tools, applications, methods, and techniques. Develops standard database queries and report templates. (25%)

Reviews, analyzes, and evaluates evidence and documents obtained from investigations. Identifies areas requiring further review and summarizes findings. (25%)

Researches Medicaid policy and medical and dental claims and coding requirements. Reviews results of claims data analysis. (25%)

Coordinates with program areas of the Office of Inspector General, including investigations, policy, audit, data analysis, medical and dental review. Coordinates with program areas of Texas Health and Human Services on matters of policy. (20%)

Performs related work as assigned. Keeps supervisor informed as required or as necessary. (5%)

Knowledge Skills Abilities:

Knowledge of health and human services programs, functions, and systems, including related local, state, and federal laws and regulations.

Experience in the investigation of fraud, waste, and abuse within health care systems.

Experience in in data analysis, research, compilation, and reporting work.

Knowledge of developing queries, designing reports, and presenting findings.

Skill in conducting data searches, in evaluating and translating large amounts of data, and in critical thinking.

Knowledge and application of reporting methodologies and tools, such as Business Objects and similar applications.

Knowledge of the Texas Medicaid program, including policy, rules, regulations, and requirements.

Knowledge of the Texas Medicaid program delivery models, including fee-for-service and managed care.

Knowledge of medical and dental claims coding (including CPT and HCPCs) and claims submission procedures, processes, and requirements.

Skill in communicating effectively orally and in writing and in presenting information.

Proficiency in use of computer software applications including, but not limited to Microsoft Office (Outlook, Word, Excel, PowerPoint, SharePoint, and Teams), Adobe Acrobat Pro, and database programs.

Experience in performing research using resources including, but not limited to Westlaw, LexisNexis Accurint, PACER, administrative and court case management systems, legislative reference sources, CPT Assistant, and the National Practitioner Data Bank.

Ability to use common office equipment including, but not limited to computers, printers, copiers, and audio-visual systems.

Ability to organize work, prioritize time, and manage multiple deadlines.

Registration or Licensure Requirements:

Certification in medical coding is preferred.

Initial Selection Criteria:

Fifteen years of full-time professional experience in work related to health care investigations.

Bachelor's degree from an accredited four-year college or university. A Master's level or advanced degree in a health care or law-related field is preferred.

Additional Information:

The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of health and human services in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.

OIG will request that all applicants considered for an interview provide responses to essay questions. Failure to respond to the request could disqualify an applicant from the interview process.

Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHS Human Resources Manual. State budget limits typically result in this position being filled in the lower end of the listed salary range.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the online application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

MOS Code:

34A, 59A, IS, 25, 8840

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

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