THIS IS A REANNOUNCEMENT PREVIOUS APPLICANTS ARE UNDER CONSIDERATION The Program Integrity Division seeks a detailed oriented health care professional to serve as an investigator for the Recipient Audit Unit. This position investigates and documents recipient Medicaid and FAMIS eligibility and claims records to assess compliance with laws, regulations and policies in response to fraud/abuse referrals. Incumbent seeks recovery of misspent funds and may refer recipients for prosecution for criminal acts.
The qualified candidate must have experience with financial and eligibility review, auditing of health care claims, investigative or audit experience, quality assurance or related areas. Requires knowledge of accounting and legal document analysis and extensive knowledge of Medicaid /FAMIS policies for all recipient eligibility categories.
Requires experience with current investigative techniques. Must have demonstrated ability to assess and apply complex legal, financial, and eligibility issues. Requires demonstrated ability to interpret and apply complex statutes and regulations, as well as analyze audit findings.
Requires experience analyzing computer-generated reports, financial, and medical records to determine irregularities and patterns of abuse. Must be proficient using the PC and software applications including databases, spreadsheets, and word processing. Proven ability to communicate effectively, verbally and in writing, including thorough explanation of policies and statutes is required.
Experience with Oracle databases or with the criminal courts system is a plus. Prefer degree with major coursework in accounting, auditing, criminal justice, human services, or related field; relevant combination of training/experience may be substituted.
A valid Virginia driver??s license is required for periodic travel to assigned regions within the state. This hourly position is limited to 29 hours per week/ 1500 hours per year.
State Of Virginia