Fraud Analyst: The West Virginia Attorney General’s Office seeks a Fraud Analyst for the Medicaid Fraud Control Unit (“MFCU”). The MFCU is charged with investigating, prosecuting and obtaining criminal and civil remedies against individuals and corporate entities responsible for improper or fraudulent Medicaid billing schemes as well as investigating and prosecuting allegations of abuse and neglect of residents in nursing homes and other residential healthcare facilities.
To fulfill these obligations, the MFCU works to identify and investigate fraud committed by hospitals, nursing homes, pharmacies, home health agencies, transportation providers, clinics, hospitals, doctors, dentists, nurses, and other Medicaid providers – as well as individuals, who, for their own financial benefit, interfere with quality healthcare or exploit Medicaid beneficiaries.
Qualified applicants must possess good judgment and the following mandatory qualifications:
- Knowledge of fundamental principles, concepts, and methods of auditing, accounting, and fiscal control
- Proficiency with Microsoft Word and Excel
- Demonstrated ability to manage multiple tasks
- Demonstrated experience inspecting and evaluating financial records
- Ability to conduct complex audits
- Ability to reason logically, analyze situations accurately, and recommend an effective course of action
- Ability to work cooperatively with attorneys, agents, support staff, technical staff, consultants, and the general public
- Excellent interpersonal, written, and verbal communication skills
- Knowledge of generally accepted accounting and auditing principles
- Ability to work independently with minimal supervision
- One to two years of relevant, progressive work experience (typically in Auditing, Investigations or Data Analysis)
- Bachelor’s degree in Accounting, Finance, Business Administration, Economics, or other relevant field. One year of relevant experience (typically in Auditing, Investigations or Data Analysis) may be substituted for each year of required education. For example: If a position requires a Bachelor’s degree and an applicant has no college credits, the applicant may substitute four years of relevant, progressive work experience for the Bachelor’s degree requirement.
Preferred qualifications include:
- A Master’s Degree in Accounting, Finance, Business Administration, Economics, or a related field
- Experience working with Medicaid or Medicare claims systems and data
- Knowledge of medical coding and billing procedures
- Certification as a Certified Public Accountant or Certified Fraud Examiner
- Experience conducting white-collar crime financial analysis, data analytics, or auditing
- Knowledge of state and federal laws pertaining to financial crimes, health care fraud, or financial exploitation
- Knowledge of methods, techniques, and audit practices related to investigations of financial crimes, health care fraud, or financial exploitation
- Knowledge of health care privacy, security, and other related regulations
- Skill in selecting, implementing, and modifying audit plans from preparatory procedures through final reports
Responsibilities will include, but not be limited to::
- Independently conducting audits and examinations related to healthcare fraud and/or the financial exploitation of vulnerable adults in Medicaid-funded facilities
- Applying statistical sampling techniques; querying, examining and analyzing Medicaid claims data; and identifying Medicaid overpayments
- Conducting forensic analysis of Medicaid claims data, medical records, and financial information provided by the Medicaid program, program providers, and other relevant entities
- Analyzing complex financial records, healthcare billing data, and other relevant information to identify patterns of fraud and relevant evidence for use in criminal and civil investigations of alleged healthcare fraud and/or financial exploitation of vulnerable adults
- Composing analysis summaries, reports of findings, and other case documentation
- Utilizing audit findings to identify violations of program regulations and applicable laws
- Preparing court and grand jury exhibits for use by MFCU attorneys and other prosecutors, and testifying as an expert witness in state and federal prosecutions
- Participating in training programs, conferences and seminars to enhance proficiency and knowledge
- Complying with the goals, policies, procedures, and strategic plans adopted and implemented by the Attorney General and/or the MFCU Director
- Performing other tasks as requested.
To apply, please submit a cover letter, resume, writing sample and preferred salary range to email@example.com with “Fraud Analyst” in the subject line.