Investigator

August 28, 2024

Dept of Health Care Finance

Washington

FULL TIME

When you become a member of Team DHCF (Department of Health Care Finance), the state Medicaid agency for the District of Columbia, you join our "Mission Possible!" We work every day, in concert with various District government agencies, to streamline access to comprehensive, affordable and quality healthcare services for District residents. Whatever your position within our agency, you will positively impact beneficiaries, their families and their future! We invite you to bring your skills, your experience and your passion to a job that makes a difference! The mission of DHCF is to ensure that comprehensive, cost-effective, quality health care services are provided for all residents of the District of Columbia ("District") that qualify for Medicaid or the Alliance (uninsured program for the District of Columbia residents) program.
JOB SUMMARY
The position serves as an Investigator within the Division of Program Integrity conducting preliminary investigations of suspected fraud, and related activities to prevent, detect and eliminate fraud and abuse by persons who provide and receive services financed by DHCF.
DUTIES AND RESPONSIBILITIES
As assigned by the Chief Investigator, conducts preliminary investigations of individual providers or beneficiaries of health care services, and drafts recommendations on the disposition of each case investigated, based on the extent to which the findings of the investigation suggest probable fraud or abuse. Analyzes computer-generated data to identify individuals and organizations that are most likely to provide evidence to ascertain whether fraud or abuse is likely to have occurred. Interviews health care beneficiaries and their informal caregivers in their homes and by telephone to determine the extent to which health care services were delivered as billed and care was delivered in accord with program requirements. Uses data collection instruments and protocols previously developed or adopted by the Division.
Actively participates in Investigations and Compliance Branch team meetings and meetings with other DHCF internal and external partners to collaborate on the detection and resolution of fraud and abuse. Prepares case documents for referral to the Medicaid Fraud Control Unit and other external agencies involved in the prosecution of health care fraud. Maintains active case files, including files of cases referred to the Medicaid Fraud Control Unit and other parties with whom information is shared. Assists in preparing testimony and other information requested by external agencies investigating or prosecuting Medicaid fraud. Remains abreast of all federal and District of Columbia rules and laws applicable to fraud and abuse and program integrity in medical assistance programs administered by DHCF. Remains abreast of rules and laws applicable to medical assistance programs administered by DHCF and maintains copies of all manuals and rules. Assists with training of DHCF staff in fraud and abuse prevention and detection, and with fraud and abuse prevention and detection activities of various local and federal law enforcement and regulatory agencies. Performs other related duties as assigned.
QUALIFICATIONS AND EDUCATION
Specialized Experience: Specialized experience is experience which is directly related to the position and has equipped the individual with the knowledge, skills, and abilities to successfully perform the duties of the position. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression.
LICENSES AND CERTIFICATIONS
None
WORKING CONDITIONS/ENVIRONMENT
The work is performed in an office setting and sedentary in nature.
OTHER SIGNIFICANT FACTS
Tour of Duty: Monday - Friday; 8:15 am - 4:45 pm
Duration of Appointment: Career Service (Permanent)
Pay Plan, Series and Grade: CS-1810-12
Promotion Potential: Promotion potential to CS-13
Salary Range: $87,339 - $111,749
Collective Bargaining: This position is covered under a collective bargaining unit, American Federation of State, County and Municipal Employees (AFSCME), Local 2401, and subject to union dues thru payroll deduction.
Position Designation: This position has been deemed security sensitive. Accordingly, the incumbent will be subject to pre-employment checks (criminal background, consumer credit check, traffic record check and drug testing, if applicable) as a condition of employment, and will be subject to periodic criminal background checks for the duration of tenure.
EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap or political affiliation