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StateJobsNY

Investigative Specialist 2 Medicaid

StateJobsNY, Albany, New York, United States, 12201

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Medicaid Investigations Investigator

The Division of Medicaid Investigations ensures the integrity of the Medicaid program by conducting investigations, recovering over payments, and implementing administrative sanctions against providers. The incumbent will aid in this endeavor using their expertise to conduct and oversee investigations of providers alleged of committing fraud, waste, and abuse. The official workstation of this position will be in Albany and supervision of Albany based investigative staff however, as business needs arise, may have responsibility for supervising staff regional offices and for oversight of investigative operations that may span statewide. Specific duties of the position include but are not limited to: Evaluating complaints of Medicaid fraud, waste and abuse and assigning complaints for investigation. Conducting regular case reviews for all staff to ensure progress meets investigative metrics and appropriate actions are taken. Working a personal caseload including complex investigations. Drafting correspondence, reports, and notices for public issuance in connection with administrative actions. Maintaining working relationships with the Special Investigative Units within Managed Care Organizations to discuss fraud trends and matters referred to OMIG. Coordinating with law enforcement, including District Attorney's to pursue criminal matters. Testifying at administrative hearings as necessary; and Ensuring recoupment of overpayments and/or sanctions where appropriate. Minimum Qualifications: Seven years of experience in conducting field investigations preliminary to administrative actions, civil litigation, or criminal prosecution. This experience must include conducting interviews of witnesses and others; taking written statements and affidavits; collecting and analyzing physical and documentary evidence; preparing detailed written reports of investigative findings; and testifying in court or at formal hearings. One year of experience must have been at a supervisory level. OR one year of permanent service as an Investigative Specialist 1. Substitutions: an associate degree in criminal justice or related field may substitute for two years of qualifying experience. A bachelor's degree in criminal justice or a related field may substitute for four years of qualifying experience. Related fields include: law enforcement, police science, criminal justice administration, criminology, criminal investigation, police studies, public justice, forensic accounting, forensic psychology, forensic science, and economic crime management. NON-QUALIFYING Investigative Experience includes but may not be limited to: Experience in routine police patrol work, security guard or related security position, tax collector, collector of delinquent accounts, credit checker, legal assistant/attorney, hotel or store detective, loss prevention officer, parole officer, correction officer, guard, inspector, or experience in adoption and/or foster care placement. Preferred Qualifications: Excellent verbal and written communication skills. Proficiency with Microsoft Office Suite and ability to learn new data systems. Organizational skills to effectively manage and monitor a significant caseload. Additional Comments: Non-Competitive, permanent, full-time. There will be minimal mandatory overtime. Routine travel is required throughout New York State to supervise staff and conduct fieldwork necessary to complete investigations. Must have a valid driver's license or otherwise demonstrate the ability to meet the transportation requirements of the position. Please be aware that because of the nature of the position, an appointment is subject to satisfactory completion of fingerprinting and background check.