State of Maryland
MEDICAL CARE PROGRAM SPECIALIST II (Regulatory Compliance Investigator Recipient
State of Maryland, Baltimore, Maryland, United States, 21276
Overview
GRADE 16 LOCATION OF POSITION MDH Office of the Inspector General for Health 201 West Preston Street Baltimore MD, 21201 Main Purpose of Job The primary purpose of the Regulatory Compliance Inspector within the Office of the Inspector General for Health (OIGH) is to lead, coordinate and investigate allegations and complaints of suspected fraud, waste and abuse potentially committed by Medicaid recipients. This is a skilled professional position which functions at the full performance level under general supervision to second line management within the Office of the Inspector General for Health (OIGH). This position completes reviews, inspections and investigations of Medicaid recipients to determine the disposition of allegations of Medicaid recipient fraud, waste and abuse based on referrals and complaints received by the Department from various internal and external private and public sources: local health departments (LHD), local Departments of Social Services (LDSS), MDH administrations, to include local state agencies and law enforcement entities. This position leads and performs a wide variety of Medicaid recipient investigations and inspections initiated by multiple referral sources that include questionable or compromising scenarios of fraud, waste and abuse, such as: family composition, citizenship and immigrant status, income sources (i.e., family income, business, proprietorship, self-employment), non-financial eligibility requirements (i.e., citizenship, residency, pregnancy, age, inmate of public institution, institution of mental disease, no private health insurance), assets, application falsification, etc. These 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, monetary recoveries and/or criminal prosecutions. This position ensures that Medicaid services are expended to recipients in accordance with Medicaid policy. This position conducts investigations and inspections in accordance with State and Federal laws, regulations and policies and pursuant to Code of Maryland Regulations (COMAR): 10.09.24.14 Medical Assistance Eligibility, 10.09.11 Maryland Children’s Health Program, and other applicable Medical Assistance COMARs; the Annotated Code of Maryland; the Affordable Care Act and Amendments; and the Health Insurance Portability and Accountability Act of 1996 (HIPPA). This position analyzes and reports findings and makes recommendations to the appropriate internal and external entities for subsequent monetary recovery and/or criminal prosecution as well as for regulatory and policy changes. This position is responsible for leading, overseeing and coordinating a wide variety of highly complex Medicaid recipient cases within any given fiscal year as cases evolve from the point of entry, through processing, to recovery and/or potential prosecution. The administrative, investigative, auditing and recovery functions of this position operate within the Fraud Detection and Determination Unit (FDDU) and significantly contribute to the OIGH’s recoveries and cost avoidance savings of more than $20 million annually. MINIMUM QUALIFICATIONS Experience: Seven years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs. Notes: Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the required experience. Candidates may substitute the possession of a Master’s degree from an accredited college or university in the related field of work for the required experience. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analysis classifications or Health Services Management specialty codes in the health-related field of work on a year-for-year basis for the required experience. DESIRED OR PREFERRED QUALIFICATIONS The desired candidate should possess the following: Experience determining eligibility for Medicaid, including experience working with Medicaid policies and procedures. Experience accessing the Maryland Health Connection website to retrieve information and documents. Experience interviewing subjects to pertinent elicit information. Experience researching government websites, social media, and other public websites to access and retrieve information. Experience drafting letters and investigative reports. Experience using Google Drive and spreadsheets. LICENSES, REGISTRATIONS AND CERTIFICATIONS Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may 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. Therefore, it is essential that you provide complete and accurate information on your application. Please report 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. 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
GRADE 16 LOCATION OF POSITION MDH Office of the Inspector General for Health 201 West Preston Street Baltimore MD, 21201 Main Purpose of Job The primary purpose of the Regulatory Compliance Inspector within the Office of the Inspector General for Health (OIGH) is to lead, coordinate and investigate allegations and complaints of suspected fraud, waste and abuse potentially committed by Medicaid recipients. This is a skilled professional position which functions at the full performance level under general supervision to second line management within the Office of the Inspector General for Health (OIGH). This position completes reviews, inspections and investigations of Medicaid recipients to determine the disposition of allegations of Medicaid recipient fraud, waste and abuse based on referrals and complaints received by the Department from various internal and external private and public sources: local health departments (LHD), local Departments of Social Services (LDSS), MDH administrations, to include local state agencies and law enforcement entities. This position leads and performs a wide variety of Medicaid recipient investigations and inspections initiated by multiple referral sources that include questionable or compromising scenarios of fraud, waste and abuse, such as: family composition, citizenship and immigrant status, income sources (i.e., family income, business, proprietorship, self-employment), non-financial eligibility requirements (i.e., citizenship, residency, pregnancy, age, inmate of public institution, institution of mental disease, no private health insurance), assets, application falsification, etc. These 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, monetary recoveries and/or criminal prosecutions. This position ensures that Medicaid services are expended to recipients in accordance with Medicaid policy. This position conducts investigations and inspections in accordance with State and Federal laws, regulations and policies and pursuant to Code of Maryland Regulations (COMAR): 10.09.24.14 Medical Assistance Eligibility, 10.09.11 Maryland Children’s Health Program, and other applicable Medical Assistance COMARs; the Annotated Code of Maryland; the Affordable Care Act and Amendments; and the Health Insurance Portability and Accountability Act of 1996 (HIPPA). This position analyzes and reports findings and makes recommendations to the appropriate internal and external entities for subsequent monetary recovery and/or criminal prosecution as well as for regulatory and policy changes. This position is responsible for leading, overseeing and coordinating a wide variety of highly complex Medicaid recipient cases within any given fiscal year as cases evolve from the point of entry, through processing, to recovery and/or potential prosecution. The administrative, investigative, auditing and recovery functions of this position operate within the Fraud Detection and Determination Unit (FDDU) and significantly contribute to the OIGH’s recoveries and cost avoidance savings of more than $20 million annually. MINIMUM QUALIFICATIONS Experience: Seven years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs. Notes: Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the required experience. Candidates may substitute the possession of a Master’s degree from an accredited college or university in the related field of work for the required experience. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analysis classifications or Health Services Management specialty codes in the health-related field of work on a year-for-year basis for the required experience. DESIRED OR PREFERRED QUALIFICATIONS The desired candidate should possess the following: Experience determining eligibility for Medicaid, including experience working with Medicaid policies and procedures. Experience accessing the Maryland Health Connection website to retrieve information and documents. Experience interviewing subjects to pertinent elicit information. Experience researching government websites, social media, and other public websites to access and retrieve information. Experience drafting letters and investigative reports. Experience using Google Drive and spreadsheets. LICENSES, REGISTRATIONS AND CERTIFICATIONS Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may 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. Therefore, it is essential that you provide complete and accurate information on your application. Please report 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. 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