Job Summary:

This position is in the Medicaid Fraud Control Unit (MFCU) within the District of Columbia Office of the Inspector General (OIG). The MFCU is a Unit responsible for investigating and prosecuting cases involving healthcare fraud by providers in the District Medicaid program and abuse, neglect, or financial exploitation of individuals residing in Medicaid-funded healthcare facilities.

Duties and responsibilities:

The incumbent serves as a Financial Analyst responsible for independent planning, coordinating, and analyzing medical claims/healthcare billing records, and financial and business records in support of criminal investigations. The incumbent works closely with MFCU Special Agents and Federal and District prosecutors to assist in determining the appropriate evidence to be obtained through IG and/or grand jury subpoenas and, if necessary, prepares subpoenas as required. The evidence may consist of healthcare claims/medical billing records, database files, financial institution or business records, contracts, expense reports, emails, and other data formats.

Reconstructs medical billing claims, partial or inadequate financial records of individuals, private companies, and/or governmental organizations; identifies unusual medical billing and financial pathways and associations; traces convoluted and obscure transactions and interrelationships; and analyzes and summarizes data from open source, law enforcement, District, and OIG data sources to support investigative reports and presentations. Presents financial and claims analysis results in a manner required by the special agent or prosecutor into cohesive reports and presentations in support of investigations. Documents data sources, maintains and organizes detailed records and files of assigned tasks and materials produced.

Qualifications and Education:

Undergraduate and Graduate Education: Major study -- finance, business administration, economics, accounting, insurance, engineering, mathematics, banking and credit, law, or other fields related to the position.

Or

Specialized experience is experienced such as performing financial transaction analysis or medical claims evaluation work requiring a comprehensive knowledge of (1) corporate finance, financial databases, programs, and any specialized fields of finance required, such as public finance, securities, international finance, money and securities markets, investments, and banking, and (2) the financial and management structure, operations, and practices of corporate and other organizations, and (3) reimbursement systems and claims processing procedures. In addition, one year of specialized experience must be equivalent to at least the next lower grade level.

Licenses and Certifications:

Certified Fraud Examiner (CFE) certification is desired.

Working Conditions/Environment:

Work is typically performed in an office setting (or cubicle), and the work area is adequately lighted, heated and ventilated.

Other Significant Facts:

Promotion Potential: No known promotional potential

Duration of Appointment: Career Service (Permanent)

Pay Plan, Series and Grade: CS-1160-12

Collective Bargaining Unit (Non-Union) - This position is not in the Collective Bargaining Unit

The position may be filled at a salary up to a Step 4.

Position Designation: This position is designated as Security Sensitive - Pursuant to section 410 of Chapter 4 of the D.C. Personnel Regulations; in addition to the general suitability screening, individuals applying for or occupying security sensitive positions are subject to enhanced suitability background check.

Submission of a resume alone is NOT a complete application. This position may require the completion of additional form/s and/or supplemental materials. Failure to provide the required information and/or materials will result in your application not being considered for employment.