Data Analyst (Specialist II), Medicaid Investigations (60012028) – Raleigh, NC

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Health insurance

Retirement plan

Vision insurance

THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF $43,500 to $52,103. Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.

The primary purpose of this analyst position is to provide criminal intelligence and data analysis, data organization and data presentation assistance to Medicaid Fraud Financial Investigators pertaining to investigations of Medicaid fraud and abuse. The employee assists Medicaid Fraud Financial Investigators and one or more teams of attorneys and investigators in the detection, investigation, and punishment of fraudulent and non-fraudulent violations of applicable criminal and civil laws pertaining to fraud and abuse by Medicaid providers and in administration of the Medicaid Program.

This analyst will also support the investigation of Medicare and other federal health care fraud cases and investigations which are primarily related to Medicaid fraud involving complex financial analysis. This individual will

  • prepare detailed spreadsheets and charts, review medical records, prepare written investigative reports, research public records, analyze facts and documents, and assist in the collection and storage of evidence.
  • receive, document, research, gather information, and prepare reports of referrals from citizens, providers, recipients, and other professionals within and outside of the Medicaid agency who report Medicaid fraud abuse.
  • must be able to suggest leads to investigators and assist in preparation of investigative requests for records, subpoenas and search warrants.
  • must also perform administrative duties to include preparation of management reports and other duties as needed.
  • This investigator typically works in the office, but may occasionally be required to work in the field to obtain pertinent information.

The successful candidate must undergo and successfully complete a comprehensive background check as part of the hiring process.

This position is subject to the Fair Labor Standards Act. This position will require travel and overnight travel

.This position is located in the Medicaid Investigations Division of the Department of Justice. The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees. These cases also protect our most vulnerable elderly and disabled citizens.

Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff. MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations. This position has the opportunity to work cases in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC State Bureau of Investigations, Sheriff’s Offices, and Police Departments

The Medicaid Investigations Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,348,028 for Federal fiscal year (FY) 2021. The remaining 25 percent, totaling $2,116,008 for FY 2021, is funded by the State of North Carolina.

MID has recovered more than $900 million in restitution and penalties. MID has helped convict hundreds of persons who defrauded Medicaid or abused patients in facilities receiving Medicaid funds.

The Attorney General’s office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.

The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the State of North Carolina in court and provides legal advice and representation to most state government departments, agencies, officers, and commissions. The Department also represents the State in criminal appeals from state trial courts, and brings legal actions on behalf of the state and its citizens when the public interest is at stake.

Note to Current State Employees:

The salary grade for this position is NC12. State employees are encouraged to apply for positions of interest even if the salary grade is the same as, or lower than, their current position. Please detail ALL work history including non-state service experience. If selected for this position, a new salary will be recalculated taking into consideration the quantity of relevant education and experience, funding availability, and internal equity. Based upon these factors, a pay increase MAY or MAY NOT result.

The State of North Carolina offers employer paid health insurance plus twelve paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at Employee Benefits.

Knowledge, Skills and Abilities / Competencies

  • Considerable knowledge of the assigned program, processes and procedures.
  • Considerable knowledge of criminal justice and law enforcement procedure, terminology. Ability to interpret, apply, and communicate statutory regulations of the assigned area.
  • Ability to analyze, interpret, recommend, and implement policy and procedural guidelines.
  • Ability to instruct and explain standards and procedures.
  • Ability to establish effective working relationships, including seeking compliance with regulations. Ability to express oneself clearly and concisely in oral and written form.
  • Ability to work independently and use sound judgment in making decisions.
  • Ability to use up-to-date spreadsheet and database software, email, Internet Web browsers, and relational databases.
  • Ability to communicate professionally.
  • Ability to provide criminal intelligence, to gather applicable records, reports, data, and other information, locate assets, and to organize and present this information to Medicaid Fraud Investigators to assist them in the investigations of Medicaid provider fraud and abuse.

Minimum Education and Experience Requirements

Bachelor s degree from an appropriately accredited institution and two years of administrative and/or technical experience in criminal justice or law enforcement as it relates to the area of assignment, or an equivalent combination of education and experience.