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REGULATORY COMPLIANCE INVESTIGATOR **REPOST**

(Medical Care Program Specialist II) Multiple FT Positions

Recruitment #23-000928-0016

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Introduction

RECRUITMENT REPOST. PREVIOUS APPLICANTS NEED NOT REAPPLY.

GRADE

16

LOCATION OF POSITION

MDH Office of the Inspector General for Health
Fraud Detection and Determination Unit
201 W. Preston Street
Baltimore MD

Main Purpose of Job

The Office of the Inspector General for Health(OIGH) is charged with investigating fraud, waste, and abuse within the Medicaid Program and to seek recovery of inappropriate payments. The OIGH investigates provider fraud and recipient fraud. This position is assigned duties related to investigating recipient fraud - is the Medicaid recipient eligible for services and was the recipient truthful in their application for benefits. There are approximately 1.1 million Maryland Medicaid recipients.

This position is responsible for performing periodic examinations and follow-up reviews of the accounts, records, procedures, and policies of MDH administrations, facilities, Local Health Departments (LHD) and local Departments of Social Services (LDSS) to ensure that all are in compliance with state and federal regulations pertaining to determinations of Medicaid eligibility.

This position performs the full range of audits and investigations and investigates allegations of fraud, waste, or abuse. This position participates in ongoing investigative activities involving the Maryland Health Insurance Program, Department of Corrections and Public Safety (DCPS), Vital Statistics Death Matches and the Department of Human Resources (DHR) Medicaid Investigations. The position also assists with federally required PERM audits as needed.

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 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.

MINIMUM QUALIFICATIONS

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

Notes: 1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the required experience.

2. Candidates may substitute the possession of a Master’s degree from an accredited college or university in the related field of work for the required experience.

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

LICENSES, REGISTRATIONS AND CERTIFICATIONS

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.

SELECTION PROCESS

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.

BENEFITS

Contractual employees who work for an agency covered under the State Employee and Retiree Health and Welfare Benefits Program, have a current employment contract and work 30 or more hours a week (or on average 130 hours per month) may be eligible for subsidized health benefits coverage for themselves and their dependents. As a contractual employee, you will be responsible for paying 25% of the premiums for your medical and prescription coverage, including any eligible dependents you have enrolled. The State of Maryland will subsidize the remaining 75% of the cost for these benefits. You can also elect to enroll in dental coverage, accidental death and dismemberment insurance, and life insurance, but will be responsible to pay the full premium for these benefits.

Leave may be granted to a contractual employee who has worked 120 days in a 12 month period. This leave accrues at a rate of one hour for every 30 hours worked, not to exceed 40 hours per calendar year.

FURTHER INSTRUCTIONS

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.




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