Government of the District of Columbia

Full-Time

Mid Level

Washington, DC, USA

$85.209 - $109.023

22 Dec → 21 Jan

Job Description

This position is located within the Department of Health Care Finance, Health Care Operations Administration, Division of Program Integrity, Investigations and Compliance Branch. The position serves as an Investigator 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.

Licenses and Certifications

A valid driver’s license is required.

Working Conditions Environment

The work is performed in a typical office setting. On site beneficiary and provider investigation work is performed in the homes of health care beneficiary and may involve visits to the offices of health care providers.

Other Significant Facts

Tour of Duty: Monday - Friday; 8:15 am - 4:45 pm

Pay Plan, Series and Grade: CS-1810-12

Promotion Potential: CS-1810-13

Collective Bargaining Unit (Union): This position is represented by a collective bargaining unit and is subject to union dues thru payroll deduction.

Position Designation: The position has been deemed security-sensitive. Accordingly, the incumbent will be subject to pre-employment checks (criminal background checks, consumer credit check, traffic record checks, if applicable) as a condition of employment, and will be subject to periodic criminal background checks for the duration of your tenure.

Vaccination Requirement: The Government of the District of Columbia values the safety of our employees, our residents, and our visitors. In support of these values, if you are selected for this job you must be fully vaccinated against COVID-19, except when vaccination is not medically advised or violates your sincerely held religious beliefs. If you are invited to join our team, you must submit proof that you are fully vaccinated against COVID-19 to your initial HR representative, or you must request an exemption from your representative. New employees must either provide proof of vaccination or be granted a medical or religious exemption before working with the Government of the District of Columbia.

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.

Job Responsibilities

  • As assigned by Chief Investigator, independently 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 and develops new data collection instruments as needed in the conduct of complex investigations.
  • 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. 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.

Requirements / Qualifications

  • Specialized Experience – Experience that equipped the applicant with the particular knowledge, skills and abilities to perform successfully the duties of the position, and this is typically in or related to the work of the position to be filled. 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 for the occupation in the organization.

  • Bachelor’s degree in a related field is preferred.

How To Apply

Apply through LegalJobs.

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