Investigator Vii Jobs

The Investigator VII (Lead) position is housed within the Provider Field Investigations (PFI), Medicaid Program Integrity unit of the Investigations & Utilization Reviews (I&UR) division of the Office of Inspector General (OIG) and reports directly to a PFI Manager. Performs highly complex administrative investigations of Medicaid providers involving allegations of fraud, waste and/or abuse in the provision and delivery of all health and human services in the state. Enforces state law relating to these services. This role requires interviewing skills, extensive research & data analysis, and the development of complex investigative reports. Work involves up to 25% statewide travel, which includes some overnight travel. The Lead Investigator works under limited supervision as the primary delegate for the PFI Manager with considerable latitude for the use of initiative and independent judgment. Supervises and coordinates the work of others. Mentors and trains junior investigative staff.
*** As of the date of this job posting, PFI investigators currently serve on a 100% mobile work status, with the understanding that the classification of mobile work is subject to revert back to a traditional on-site work or telework environment based upon agency needs and/or upon employee performance at any time. See additional information section below for more information on mobile work requirements. ***
Essential Job Functions

• Performs other duties as assigned or required to maintain division operation. Keeps manager informed as required or as necessary. (5%).
• Researches, reviews, and investigates highly advanced complaints and cases alleging Medicaid provider fraud, waste, and/or abuse and recommending action(s) as appropriate. Interprets and applies applicable agency, state and federal policies, procedures, rules, and regulations. Performs timely investigative duties in conformity with PFI policies and procedures, including but not limited to case-specific deadlines assigned by management. Completes no fewer than three full-scale investigations per year. Gathers, analyzes, and interprets business, financial, and medical documentation. Conducts interviews with recipients, witnesses, providers, complainants, and provider’s staff regarding investigations. (40%)
• Makes consultative visits and establishes liaisons with the Attorney General’s Medicaid Fraud Control Unit, the Antitrust and Civil Medicaid Fraud Division, other state and federal agencies, licensure boards, and other external entities to discuss and/or coordinate Medicaid provider fraud and abuse investigations; interpret program policies, standards, and procedures; conduct training workshops; participate in joint investigations and provide advice and recommendations. (5%)
• Evaluates, summarizes, and communicates investigative findings through video/oral/written communications. Prepares detailed, comprehensive, and grammatically correct case summaries for each assigned case. Performs timely administrative duties associated with investigations in conformity with applicable PFI policies and procedures, including but not limited to investigative timelines. (10%)
• Develops comprehensive exhibits, including but not limited to a schedule of incorrect claims, to ensure effective case presentations in administrative hearing and court cases, when required. Testifies and presents evidence in informal reviews and judicial proceedings (before administrative, civil, and criminal courts) as needed. (10%)
• Assists with developing and conducting training. Mentors and assists co-workers and staff from other OIG divisions and HHS Enterprise agencies, when appropriate and as needed. Assists with developing and preparing appropriate training and operational manuals, educational materials, and information, when appropriate and as needed. (5%)
• Acts as the primary delegate for the PFI Manager. Plans, assigns, and supervises the work of others. Develops, coordinates, and oversees highly complex projects and initiatives. Mentors and trains junior investigators. Ensures junior staff comply with established policy, procedure, recognized guidelines and meet key metrics. (10%)
• Develops, recommends, and implements solutions to problems. Reviews, develops, and recommends guidelines, procedures, policies, rules, and regulations to detect and prevent Medicaid fraud, waste, and program abuse. Self-initiates cases or projects designed to generate cases to prevent, detect and investigate fraud, waste and abuse not reported through the referral or MPI Intake process. (5%)
• Effectively communicates findings to the PFI Manager, Deputy Inspector General for MPI, other HHSC staff, and external entities. Provides testimony and presents evidence in formal hearings and court proceedings; develops and presents criminal fraud cases to criminal prosecutors, when appropriate. (10%)

Knowledge Skills Abilities
Advanced knowledge of investigative principles, techniques, and procedures; of the laws governing the activities regulated by the agency; and of court procedures, practices, and rules of evidence.
Advanced knowledge of Medicaid program policies and procedures and knowledge of fraud and abuse rules and regulations.
Ability to understand, interpret, and appropriately apply policies, procedures, rules and regulations.
Ability to plan, organize, and conduct complex investigations, surveys, inspections, and examinations; to conduct interviews and gather facts; to evaluate findings and prepare complex, concise legal reports; and to testify in hearings and court proceedings.
Ability to communicate effectively both orally and in writing.
Ability to establish and maintain effective working relationships with supervisory personnel, co-workers, providers, attorneys and individuals from other state and federal agencies and boards.
Ability to use personal computers and related software, to include an intermediate level competency with MS Word and Excel.
Ability to prioritize tasks; work under time constraints and under minimal supervision.
Ability to work in a virtual environment with tools such as MS Teams, Zoom, WebEx and/or other similar platforms.
Ability to plan, assign and/or supervise the work of others.
Ability to lead and mentor less-tenured staff and act as primary delegate for PFI Manager.
Ability to travel up to 25% of the time, to include statewide and/or overnight travel.
Knowledge using Medicaid Fraud Abuse and Detection System [MFADS], Business Objects and PI Case Tracker.
Registration Or Licensure Requirements
N/A
Initial Selection Criteria
Four years of experience conducting OIG PFI full-scale investigations. Experience in another area at the OIG may be substituted for one of these years of required PFI experience.
Graduation from a four-year college or university with major coursework in a related field is preferred.
Experience Mentoring, Developing And Training Others.
Experience using a computer and software such as Word and Excel.
Preferred Education, Designations, Qualifications, And/or Skills

• Graduate Degree in Public Administration, Public Health, Public Policy (or similar)
• Licensed Professional Counselor (LPC)
• Juris Doctorate (JD)
• Certified Fraud Examiner (CFE)
• Certified Internal Auditor (CIA)
• Bilingual in English/Spanish
• Licensed Clinical Social Worker (LCSW)
• Accredited Healthcare Fraud Investigator (AHFI)
• Registered Nurse (RN)

Additional Information
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must submit to a name-based, or in some instances a fingerprint based, criminal background check through Texas Department of Public Safety (DPS) to determine if an applicant has a conviction for a Class A misdemeanor within the last five years or a felony that constitutes a bar to employment.
Applicants selected for interviews will be required to submit pre-interview essay question responses and complete a written, timed exercise following the interview. Failure to respond to the request could disqualify an applicant from the interview process.
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual. State budget limits typically result in this position being filled in the lower end of the listed salary range.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888—894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
This position requires the frequent development and completion of complex legal documents and reports. This position also requires extensive data analysis and familiarity in working with and manipulation of large amounts of data within Microsoft Excel. An in-basket test related to Excel utilization, data analysis and writing skills may be required following applicant interviews.
Mobile work refers to mandatory work arrangements in which an employee’s officially assigned duties require frequent travel to client and/or provider locations. When the employee is not traveling to these locations, the employee performs regular work duties at their residence.
As such, applicants may be hired from any geographic area of the State of Texas where HHS has a physical office location with available space. If selected for this position, the closest HHS offices to the applicant residence will be reviewed for availability of space. Employees will be provided a workspace, which could include shared office or cubicle space.
In addition to performance of mobile investigative fieldwork, statewide travel (including overnight travel) to an HHS office will be intermittently required to perform this role and to attend mandatory training.
Mobile workers will have a designated office location but may also have a shared desk space they can use at a remote business office location. Mobile workers are not included in the CAPPS telework registry. Mobile work is not optional, it is a requirement of a person's job.
Employees are responsible for providing the necessary infrastructure for working at home, including an office space that affords the employee with privacy to discuss confidential investigative information, office furnishings (desk, chair, lamps, etc.), and utilities (reliable internet, electricity, telephone). The agency will not reimburse for utilities, or any items purchased for use at home, including office supplies, internet service, or maintenance or repair of personally owned equipment. The agency will provide a laptop, two monitors and cellular phone.
MOS Code
31B, 31D, EOD, 401, 5819, 7S0X1
Top 10 Tips for Success when Applying to Jobs at HHSC and DSHS
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.