Job Details

Job Description

GENERAL DESCRIPTION

The Healthcare Program Enforcement Division of the Office of the Attorney General is seeking an Auditor whose work will involve auditing work for filed qui tam cases and other investigations as needed. Work involves examining, investigating, and reviewing medical claims data, records, reports, financial statements, and management practices to ensure legal compliance with state statutes and internal regulations relating to medical providers participating in state health insurance programs.

The OAG is a dynamic state agency with over 4,000 employees throughout the State of Texas. As the State's law firm, the OAG provides exemplary legal representation in diverse areas of law. OAG employees enjoy excellent benefits ( along with tremendous opportunities to do important work at a large, dynamic state agency making a positive difference in the lives of Texans.

ESSENTIAL POSITION FUNCTIONS

• Performs entry-level audits/criminal/civil investigations and examinations of alleged Medicaid and healthcare provider fraud.
• Queries, examines, and analyzes Medicaid claims data to contribute to an efficient, team-oriented investigation; applies statistical sampling techniques to claims data as necessary; obtains information and data from a variety of systems to contribute to investigations; and collects and analyzes case evidence, including business records, financial records, banking records, and medical records.
• Documents audits/investigations by preparing detailed audit/civil investigative reports, opening memos, and closing memos in a professional, correct, and timely manner, consistent with HPED guidelines.
• Assists with outreach presentations to outside agencies, associations, or groups, whose assistance and cooperation can enhance the mission of HPED.
• Performs related work as assigned
• Maintains relevant knowledge necessary to perform essential job functions
• Attends work regularly in compliance with agreed-upon work schedule
• Ensures security and confidentiality of sensitive and/or protected information
• Complies with all agency policies and procedures, including those pertaining to ethics and integrity

Qualifications:

MINIMUM QUALIFICATIONS

Auditor II:

• Education: Graduation from high school or equivalent
• Education: Bachelor's degree from an accredited college or university; experience in the following (or closely related) fields may be substituted for the required education on a year-for-year basis: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid, or Medicare. CFE credential preferred.
• Experience: 2 years of full-time experience working in the following (or closely related) fields: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid, or Medicare; may substitute a master's degree from an accredited college or university for two years of the required experience
• Knowledge of word processing and electronic spreadsheet applications
• Skill in handling multiple tasks, prioritizing, and meeting deadlines
• Skill in effective oral and written communication
• Skill in exercising sound judgment and effective decision making
• Ability to receive and respond positively to constructive feedback
• Ability to work cooperatively with others in a professional office environment
• Ability to provide excellent customer service
• Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG workspace within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave)
• Ability to arrange for personal transportation for business-related travel
• Ability to work more than 40 hours as needed and in compliance with the FLSA
• Ability to lift and relocate 30 lbs.
• Ability to travel (including overnight travel) up to 10%

Auditor III - All of the above qualifications for an Auditor II, PLUS:

• Experience: 2 additional years of full-time experience working in the following (or closely related) fields: accounting, auditing, compliance monitoring, health care insurance, law enforcement, Medicaid, or Medicare; may substitute a master's degree from an accredited college or university for two years of the required experience

TO APPLY

To apply for a job with the OAG, electronic applications can be submitted through CAPPS Recruit. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code. Military Crosswalk information can be accessed at



THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER