MEDICAL CARE PROGRAM SPECIALIST II

REGULATORY COMPLIANCE INVESTIGATOR

MDH, Office of the Inspector General, 201 W. Preston Street, Baltimore, MD

This position functions at the full performance level complying with all applicable State and federal law and regulations in it's billing practices with the intended purpose of preventing fraud, waste and abuse of departmental funds. This position ensures that violations of Medicaid resources expended through Medicaid programs and services are investigated in accordance with The Affordable Care Act, State and Federal laws, regulations and policies. The administrative, investigative, auditing and recovery functions of this position operate within the Fraud Detection and Determination Unit (FDDU) and significantly contribute to the OIG's recoveries and cost avoidance savings of more than $20 million annually. This position performs the full range of audits, inspections, and administrative investigations and investigates any substantial fraud, corruption, abuse of authority, misappropriation of Medicaid monies and/or other alleged activity or conduct resulting in the loss or waste of operational resources. This position functions as an integral part of the investigative team that performs federally mandated reviews for the Payment Error Rate Measurement (PERM) project. As a member of the Unit, this position provides policy expertise, support, guidance and clarification of findings to PERM team members. This project is responsible for the audit, review, investigation and documentation of fraudulent Medicaid recipient payments which span various eligibility programs which are administered by the LDSS and LHD. This position participates in ongoing investigative activities involving the Children's Health Insurance Program (MCHP), Department of Corrections and Public Safety (DCPS), Vital Statistics Death Matches and the Department of Human Resources (DHR) Medicaid Investigations. These specific and unique duties are frequently of a confidential and sensitive nature and are conducted in accordance with The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Code of Maryland Regulations (COMAR 10.09.24 and 10.09.36). This position ensures that private health information entrusted to the Department is appropriately protected from disclosure. Each audit, investigation or inspection results in a report with recommendations which may include, license revocation, recoveries, and or civil money prosecutions.

Education:    A Bachelor's degree from an accredited college or university.

Experience:  Three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.

NOTE:

1.  Additional administrative or professional experience applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs or in a health or human service program may be substituted on a year-for-year basis for the required education.

2.  A Master's degree in the related field of work can be substituted for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analyst classifications or Health Services Management specialty codes in the health related field of work on a year-for-year basis for the required experience and education.

The successful applicant should have experience with determining Medical Assistance eligibility or interpreting Medical Assistance eligibility regulations.

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.