Medicaid Fraud Financial Examiner 4

Responsibilities

Position and Salary Information
The Attorney General’s Office is recruiting for a permanent full time Financial Examiner 4 in the Medicaid Fraud Control Division. This position is located in Olympia, Washington, and Is represented by the Washington Federation of State Employees (WFSE).

Financial Examiner 4 Salary Range 70: $84,192 – $113,160
The base pay offered will take into account internal equity and may vary depending on the preferred candidate’s job-related knowledge, skills, and experience.

The following stipends may apply based on position requirements:

• Incumbents assigned to our Seattle office location receive an additional 5% King County Location Pay stipend.
• Incumbents assigned to a position designated as requiring dual language skills will receive a 5% Dual Language Requirement Pay stipend.

What does a Financial Examiner 4 do?

SUPERVISION:
This position has supervisory responsibility for three (3) direct reports with the classification of Financial Examiner 3 and will:

• Ensure direct reports are maintaining case work information in accordance with the MFCD Operations Manual, including, but not limited to, Law Manager entries and maintaining information in the appropriate Outlook, F:drive folders, FAS folders, and FAS workload tracking spreadsheet.
• Provide meaningful, viable and timely guidance to direct reports regarding their assigned activities and ensure assigned work is completed in a timely manner; conduct personnel evaluations and other required personnel paperwork, as well as approve leave requests for direct reports; prepare reports and associated documents concerning the performance of audits, data analytics and financial examinations and ensure that direct reports are accurately documenting their time in timekeeping; manage requests from the various sections in the Division and prioritize tasks for direct reports.

REVIEW/EVALUATE DIRECT REPORT: 
Planning and creating methodologies to identify and examine aberrant health care provider billing and financial misconduct, utilizing statistical valid sampling to conduct audits, examining and conducting analysis of complex financial transactions from financial institutions, performing forensic accounting review, utilize financial investigative software to examine and analyze financial documents/electronic banking, retrieving data sets from systems of regulated entities to investigate complex civil and criminal financial fraud in the most complex regulated industries of Medicaid and Qui Tam whistleblower actions in fee-for-service (FFS) and in managed care entities – who are funded through a capitated payment system and whose funding and rates are determined by historical expenditures and actuarial standards.

Developing complex data queries by using multiple software programs to access multiple data sets, analyzing billing and other data, mining data to identify potential fraudulent billing, and conducting financial and/or health care audits and civil/criminal investigations of pharmaceutical and other manufacturers of medical products, pharmacies, hospitals, skilled nursing facilities and other licensed and unlicensed facilities housing or caring for Medicaid recipients or receiving Medicaid funding, in support of MFCD investigations or inquiries and identifies fraudulent activity within audited facilities and provider practices.

Retrieving, evaluating, and analyzing all sources of data including paper documents, electronic, encounter, billing, actuarial, statistical data, rate setting, financial reports and other forms of data pertaining to the Medicaid program, including Managed Care and nursing facility entities; preparing audit, analytical, investigative, administrative reports, spreadsheets or associated documents; advising management concerning audit processes results and identifying areas of Medicaid program and process enhancement.

Logging, compiling, and extracting data to create documents and reports required to complete financial analysis/examinations; reading, analyzing, and examining filings, documents, and other information to assess the most complex regulated entity’s compliance with laws, regulations, and standards; prepares and completes checklists and/or additional analysis/examination of procedures/programs; evaluating analysis/examination procedures, programs, and finding. Writing analysis/examination reports for assigned cases.

Preparing reports, spreadsheets and other documents related to data analysis and investigative activities; assisting other federal and state audit and law enforcement agencies.
This is an expert level position representing the Washington State Attorney General’s Office in their interactions with regulated entity and healthcare provider fraud schemes and patterns of misconduct in the Medicaid program and long term care services for vulnerable adults including residential care facilities and personal care services. Fraud, and abuse and neglect cases are investigated through analyzing various types of financial records, healthcare records, and examination and evaluation of the adequacy of an institution’s or healthcare provider’s asset/liability management processes.

This position requires the individual to:
Stay apprised of complex regulations – both state and federal, to include but not limited to: Medicaid and Medicare program coverage, payment and compliance rules and regulations, applicable state agency rules and regulations to include licensing and certification of healthcare providers, federal and state false claim acts, anti-kickback and rebate regulations, Stark law, money laundering, and financial and banking institution regulations. Therefore, the individual must read and review updated applicable laws, regulations, and standards using both text and computer-based sources to ensure analyses and examinations are appropriately conducted; and interpret and apply applicable laws, rules, and standards.

Analyze financial statements includes income statements, balance sheets, cash flow and checks to assist with identifying fraud through the accuracy and completeness of current accounting standards. Conduct revenue and expenses records review to identify improper transactions. Assess accounts receivable and payable to confirm the accuracy of balances, invoices and analyze payment terms and aging records. Review financial records and medical data to ensure compliance with applicable laws, regulations and industry standards.
Reconstruct and analyzes various types of financial records, evaluates the adequacy of an institution’s asset/liability management processes by analyzing the institution’s exposure to changing interest rate environments; reviews fraud activities in Medicaid, financial institutions or financial service providers or issuers; analyzes/examines most complex regulated entities and determines compliance with applicable laws, regulations, and standards including, but not limited to, Medicaid and residential facility compliance, financial compliance, investment compliance, audit failure, antitrust, security sale compliance, or “Ponzi” schemes on a state, national, and international level.

This recruitment announcement may be used to fill multiple open positions for the same classification, in addition to the position(s) listed in this announcement.