Medicaid Provider Fraud & Abuse Investigator

Full Time
Lincoln, NE
Posted
Job description
Description
The Department of Health and Human Services (DHHS), Division of Medicaid & Long-Term Care is looking for a strategic partner for the position of Medicaid Fraud and Abuse Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS.

You have the passion, we have the opportunities – let’s make a difference for Nebraskans.

What we can offer you:
  • Stable Employment Opportunity
  • Career Development and Learning
  • Tuition Reimbursement
  • 156% match of first 4.8% contribution to Retirement Plan
  • 13 Paid Holidays
  • Generous Leave Accruals and Benefits
  • Opportunity to be part of a caring organization

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex, age, national origin, disability, marital status, or genetics.

Job location is the Nebraska State Office Building, Downtown.

Monday-Friday, 8 AM-5PM
Examples of Work
Every individual within DHHS makes an impact. In this role, the essential job functions you will perform:

  • Compile and analyze claims data and medical records;
-Coordinate investigatory actions with appropriate program specialists, the Office of the Inspector General, FBI, and law enforcement officials as necessary; -Interview providers and/or witnesses to obtain information;
  • Interpret and apply State and Federal Medicaid rules and regulations to determine outcomes of cases investigated;
  • Implement and/or recommend new and revised Medicaid policy, procedures, and provider bulletins; and
  • Plan and coordinate audits and reviews including (but not limited to) the Payment Error Rate Measurement and Unified Program Integrity Audit Contractor audits.

*Must have ability to travel as projects/initiatives dictate, and work 8-5 core hours in addition to varied hours based on workload and project requirements.*
Qualifications / Requirements

REQUIREMENTS: Post high school coursework/training in law enforcement, criminal justice, social/behavioral sciences or health related field, nursing, business or public administration, management, program analysis or evaluation of data systems OR Experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports and evaluating their use of effectiveness, policy planning/analysis, casework, nursing, accounting or billing systems.

PREFERRED: Higher preference may be given to those with experience working with Medicaid claims, MMIS, and/or Medicaid provider regulations. The ideal candidate will also have experience in working on projects and/or implementing new initiatives and be a Certified Professional Coder (CPC) or a registered nurse.

OTHER: Valid driver's license or the ability to provide independent authorized transportation. Ability to travel as projects/initiatives dictate, and ability to work 8-5 core hours in addition to varied hours based on workload and project requirements

Knowledge, Skills and Abilities

Applicants must have excellent computer (word processing, database, spreadsheet, desk-top publishing, and on-line research) skills, and strong organizational and writing skills. Must be able to work efficiently and effectively as an individual and as part of a team. Attention to detail and accuracy, and a strong ability to handle multiple tasks concurrently are essential.


We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

Check out all that the State of Nebraska has to offer! For more information on benefits currently offered to permanent teammates, please visit: https://statejobs.nebraska.gov/index.html#benefits

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