Investigator - Medicaid Fraud

Georgia Office of the Attorney General
Atlanta, GA

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Job Details

From $50 an hour

Qualifications

Criminal procedure
Computer operation
Healthcare financial misconduct investigations
Cash flow analysis
Trial material preparation assistance
Report writing
Legal presentation of evidence
Presentation software
Finance
Managing court exhibits
Bachelor's degree in finance
Spreadsheets
Healthcare Administration
Court testimony
Bachelor's degree in business
Certified Fraud Examiner
Digital forensics software
Collaborating with government agencies
Mid-level
Witness interviewing
Finance
Criminal Justice
Analysis skills
Search and seizure law enforcement
Financial records review
Trial attendance assistance
Collaborating with law enforcement agencies
Healthcare billing investigations
Data interpretation
Legal evidence

Full Job Description

The Office of the Attorney General

Department of Law

Medicaid Fraud Division - Civil Investigator

The mission of the Department of Law is to serve the citizens of the State of Georgia by providing
legal representation of the highest quality to the agencies, officers and employees of state government
and by honorably and vigorously carrying out the constitutional and statutory responsibilities of the
Attorney General. The Department of Law is organized into the Executive Office, five legal
divisions, four specialty units and an operations division. The position filled through this
announcement will serve in the Investigations section of our Medicaid Fraud Division.

Duties & Responsibilities:
Investigators conduct health care fraud investigations. Assists criminal justice personnel, including,
but not limited to, Analysts, Auditors, and Prosecutors in conducting on-site health care fraud and
patient abuse investigations.
Develops necessary knowledge and skills for using computer software programs in unit investigations.
Maintains and applies professional knowledge of current trends and developments related to work unit
assignments. Positions are typically non-POST and do not require POST Certification.

Responds to assignments and requests for assistance in health care fraud and patient abuse investigations in a timely manner.

Responds to assignments and requests for assistance by reviewing documentation, conducting
interviews, and gathering intelligence information for health care fraud investigations and patient
abuse investigations.

Participates in the planning and gathering of information for investigations involving health care
fraud and patient abuse investigations.

Assists in executing on-site search warrants to obtain evidence of health care fraud and patient
abuse. Assists in the identification and seizure of health care fraud evidence during the execution
of on-site search warrants.

Assists in preparing charts, schedules, and presentations for the prosecution of health care fraud
cases.

Follows appropriate laws, guidelines, and policies in maintaining the chain of custody for
evidence.

Collects, reviews, and evaluates the necessary documents to identify and investigate health care
fraud and patient abuse, including medical records, health care providers' billing records, and
records.

Assists in developing databases to analyze appropriate medical data. Enters data into databases and
analyzes the data for evidence.

Assists in conducting source and expenditure analyses and cash flow analyses of suspects in health
care fraud investigations and patient abuse investigations.

Assists in searching public records, governmental databases, and commercial databases for
evidence of health care fraud and patient abuse allegations.

Assists the appropriate parties in identifying potential assets subject to seizure due to health care
provider fraud.

Assists the appropriate parties in organizing, analyzing, and processing items of evidence and other
documentation for investigation and prosecutorial purposes in health care fraud and patient abuse
investigations.

Utilizes computers and the appropriate software to conduct health care fraud and patient abuse
investigations.

Demonstrates a basic knowledge of computer software in creating databases, spreadsheets, graphs,
and presentations.

Demonstrates the appropriate computer skills to conduct health care fraud investigations.

Prepares appropriate reports in a timely, thorough, and accurate manner.

Prepares thorough and accurate reports documenting interviews of witnesses and suspects in a
timely manner.

Prepares thorough and accurate reports documenting the execution of search warrants and the
seizure of evidence in a timely manner.

Prepares thorough and accurate reports documenting the analyses of financial databases and
conclusions of the analyses in a timely manner.

Prepares thorough and accurate reports documenting public record and database searches and
conclusions from the searches in a timely manner.

Prepares thorough and accurate case reports for all investigative activities in a timely manner.
Distributes copies of reports to the appropriate parties in a timely manner.

Presents courtroom testimony utilizing proper courtroom demeanor and assists prosecutors in
coordinating pre-trial activities.

Provides accurate testimony concerning health care fraud investigations and patient abuse
investigations.

Demonstrates knowledge of court system operations and methods of presenting testimony.
Coordinates and prepares courtroom testimony with the appropriate prosecuting attorney.
Demonstrates skills to be a witness and/or evidence coordinator on behalf of the prosecuting
attorneys to ensure that all evidence and witnesses are available for presentation.

Maintains supplies, reports, equipment, and relationships with other agencies according to established Unit requirements.

Maintains assigned equipment based on Department policy and standards. Completes applicable
reports in a timely manner.

Demonstrates skills that allow the development of relationships and liaisons with other agencies,
departments, and the public.

Maintains professional knowledge of current trends and developments in the field and applies pertinent new knowledge to the performance of other responsibilities.

Participates in seminars and professional meetings when available and approved in advance.
Maintains professional knowledge by reading up-to-date articles, books, and periodicals.
Applies pertinent new knowledge to the performance of assigned responsibilities.

Interacts with all levels of state and local government in a way that promotes respect, encourages cooperation, and contributes to excellent performance.

Treats all other state and local personnel fairly, giving preferential treatment to no one.
Communicates accurate information to all other state personnel in a professional and courteous
manner that conveys a willingness to assist.

Accepts direction and feedback from supervisors and follows through appropriately.
Accepts responsibility for mistakes and takes action to prevent similar occurrences.
Uses appropriate established channels of communication.
Maintains relationships and liaisons with other agencies, departments, and the public according to
Unit requirements.

The above statements are intended to describe the general nature and level of work being performed
by persons assigned to this title. They may not include all job duties performed by employees on this
job title, and every position does not necessarily require these duties.

Minimum Qualifications:
Twelve months of fraud investigation or related experience.

Preferred Qualifications:
Preference will be given to applicants who possess one or more items below:

POST-Certification
Completion of a Bachelor’s degree from an accredited four-year college or university with a
major in Criminal Justice, Healthcare Administration, Accounting, Business and Finance.

Certified Fraud Examiner
Digital Forensics Experience
Law enforcement experience
Demonstrated analytical skills

To move forward in the recruiting process, ALL External applicants are required to:

Attach a current Resume
Cover Letter
Attach "Department of Law Employment Application" (click link to obtain: http://law.georgia.gov/careers/application-forms)
Attach copies of official undergraduate transcripts (unofficial copies are accepted for application process)
Answer all prescreening questions
If the file is too large to attach please email the document(s) to [email protected] to include the position title - application material(s) in the subject line

Additional Information:

A criminal background check is completed on all candidates; employment is also contingent upon the completion and satisfactory results of the background investigation. Candidates that are being strongly considered for the position will also be required to submit a Department of Law employment application & waiver, Georgia Department of Revenue Tax Clearance letter and copies of official college transcripts.

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All applicants will be considered, but may be screened for the preferred qualifications of the position, and may not necessarily receive an interview. Human Resources maintains the discretion to close the job announcement prior to the closing date if a significant number of applications are received.

SALARY: Starting in the $50's and COMMENSURATE WITH EXPERIENCE