State of Maryland
ADMINISTRATOR II (Investigator Medical Fraud)
State of Maryland, Baltimore, Maryland, United States, 21276
GRADE
17
LOCATION OF POSITION MDH Office of the Inspector General for Health 201 West Preston Street Baltimore, MD 21201
MAIN PURPOSE OF JOB This position functions at full performance level under general supervision to a second line managerial position within the Maryland Office of the Inspector General for Health (OIGH). This position is responsible for investigating, overseeing and coordinating cases of fraud, waste and abuse of health care providers, contractors and grantees who deliver Medicaid services. The position ensures that non‑compliance and violations of Medicaid resources expended through Medicaid programs and services are investigated in accordance with State and Federal laws, regulations and policies, including: Code of Maryland Regulations (COMAR) – approximately 59 program areas; the Affordable Care Act and Amendments; the Health Insurance Portability and Accountability Act of 1996; and multiple other statutes, policies and procedures governing and regulating physicians and allied health care providers who administer services to Medicaid recipients under the Medicaid/Medical Assistance Program for the entire State of Maryland. This position analyzes and reports findings and makes recommendations to the appropriate internal and external entities and authorities for fiscal assessment, subsequent monetary recovery and/or civil/criminal prosecution.
This position performs complex and a wide variety of Medicaid provider investigations and inspections initiated by multiple referral sources that include questionable or compromising scenarios of fraud, waste and abuse. This position ensures that Medicaid services are expended to recipients in accordance with Medicaid policy and the specific and unique duties are of a confidential and sensitive nature and are conducted in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Investigations or inspections result in reports with recommendations which may include fiscal assessment, compliance and performance measures for improvements, monetary recoveries and/or civil/criminal prosecutions.
Under the authority and direction of the Inspector General, this position functions as a member of the OIGH investigation team with the responsibility for the collaborative and ongoing activities involving internal and external entities within State and Federal governments to ensure program integrity. Additionally, this position responds to Department internal and external audits, administrative investigations or inspections of legislative audit findings and recommendations. The functions of this position significantly contribute to the OIGH’s recoveries and cost avoidance savings of more than $20 million annually.
MINIMUM QUALIFICATIONS Education: Graduation from an accredited high school or possession of a high school equivalency certificate.
Experience: Five years of administrative staff or professional work.
Notes:
Candidates may substitute 30 credit hours from an accredited college or university for each year up to four years of the required experience.
Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and one year of experience in administrative staff or professional work for the required experience.
Candidates may substitute the possession of a Master's degree from an accredited college or university for the required experience.
Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year‑for‑year basis for the required experience.
DESIRED OR PREFERRED QUALIFICATIONS The desired candidate should possess the following:
A Certified Professional Coder (CPC) certification.
Experience with applying, interpreting and understanding medical billing, and medical coding, including HCPCS, ICD-10, and CPT.
Experience analyzing medical codes to detect incorrect usage of medical codes and identifying fraudulent upcoding.
LICENSES, REGISTRATIONS AND CERTIFICATIONS Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.
SELECTION PROCESS Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. It is essential that you provide complete and accurate information on your application, including all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). Complete applications must be submitted by the closing date. Information submitted after this date will not be added. Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application. Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.
BENEFITS STATE OF MARYLAND BENEFITS
FURTHER INSTRUCTIONS Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114‑B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment; no postmarks will be accepted. If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested information to 410‑333‑5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time. For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410‑767‑1251. If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410‑767‑4850 or Application.Help@maryland.gov. Appropriate accommodations for individuals with disabilities are available upon request by calling: 410‑767‑1251 or MD TTY Relay Service 1‑800‑735‑2258. We thank our Veterans for their service to our country. People with disabilities and bilingual candidates are encouraged to apply. As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.
#J-18808-Ljbffr
LOCATION OF POSITION MDH Office of the Inspector General for Health 201 West Preston Street Baltimore, MD 21201
MAIN PURPOSE OF JOB This position functions at full performance level under general supervision to a second line managerial position within the Maryland Office of the Inspector General for Health (OIGH). This position is responsible for investigating, overseeing and coordinating cases of fraud, waste and abuse of health care providers, contractors and grantees who deliver Medicaid services. The position ensures that non‑compliance and violations of Medicaid resources expended through Medicaid programs and services are investigated in accordance with State and Federal laws, regulations and policies, including: Code of Maryland Regulations (COMAR) – approximately 59 program areas; the Affordable Care Act and Amendments; the Health Insurance Portability and Accountability Act of 1996; and multiple other statutes, policies and procedures governing and regulating physicians and allied health care providers who administer services to Medicaid recipients under the Medicaid/Medical Assistance Program for the entire State of Maryland. This position analyzes and reports findings and makes recommendations to the appropriate internal and external entities and authorities for fiscal assessment, subsequent monetary recovery and/or civil/criminal prosecution.
This position performs complex and a wide variety of Medicaid provider investigations and inspections initiated by multiple referral sources that include questionable or compromising scenarios of fraud, waste and abuse. This position ensures that Medicaid services are expended to recipients in accordance with Medicaid policy and the specific and unique duties are of a confidential and sensitive nature and are conducted in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Investigations or inspections result in reports with recommendations which may include fiscal assessment, compliance and performance measures for improvements, monetary recoveries and/or civil/criminal prosecutions.
Under the authority and direction of the Inspector General, this position functions as a member of the OIGH investigation team with the responsibility for the collaborative and ongoing activities involving internal and external entities within State and Federal governments to ensure program integrity. Additionally, this position responds to Department internal and external audits, administrative investigations or inspections of legislative audit findings and recommendations. The functions of this position significantly contribute to the OIGH’s recoveries and cost avoidance savings of more than $20 million annually.
MINIMUM QUALIFICATIONS Education: Graduation from an accredited high school or possession of a high school equivalency certificate.
Experience: Five years of administrative staff or professional work.
Notes:
Candidates may substitute 30 credit hours from an accredited college or university for each year up to four years of the required experience.
Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and one year of experience in administrative staff or professional work for the required experience.
Candidates may substitute the possession of a Master's degree from an accredited college or university for the required experience.
Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year‑for‑year basis for the required experience.
DESIRED OR PREFERRED QUALIFICATIONS The desired candidate should possess the following:
A Certified Professional Coder (CPC) certification.
Experience with applying, interpreting and understanding medical billing, and medical coding, including HCPCS, ICD-10, and CPT.
Experience analyzing medical codes to detect incorrect usage of medical codes and identifying fraudulent upcoding.
LICENSES, REGISTRATIONS AND CERTIFICATIONS Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.
SELECTION PROCESS Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. It is essential that you provide complete and accurate information on your application, including all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). Complete applications must be submitted by the closing date. Information submitted after this date will not be added. Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application. Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.
BENEFITS STATE OF MARYLAND BENEFITS
FURTHER INSTRUCTIONS Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114‑B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment; no postmarks will be accepted. If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested information to 410‑333‑5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time. For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410‑767‑1251. If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410‑767‑4850 or Application.Help@maryland.gov. Appropriate accommodations for individuals with disabilities are available upon request by calling: 410‑767‑1251 or MD TTY Relay Service 1‑800‑735‑2258. We thank our Veterans for their service to our country. People with disabilities and bilingual candidates are encouraged to apply. As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.
#J-18808-Ljbffr