Description

 The Medicaid Fraud Control Unit (MFCU) is charged with investigating, prosecuting and obtaining criminal and civil remedies against individuals and corporate entities responsible for improper or fraudulent Medicaid billing schemes, as well as investigating and prosecuting allegations of abuse and neglect of residents in nursing homes and other residential healthcare facilities. To fulfill these obligations, the MFCU works to identify and investigate fraud committed by hospitals, nursing homes, pharmacies, home health agencies, transportation providers, clinics, hospitals, doctors, dentists, nurses, and other Medicaid providers – as well as individuals, who, for their own financial benefit, interfere with the quality of healthcare, or exploit Medicaid beneficiaries.

Under supervision of the Chief Forensic Auditor, the Data Analyst will collect, compile, analyze, and interpret trends or patterns in complex medical data sets or other available information. They will formulate analyses and prepare reports, in addition to testifying in court as needed. They will also be responsible for performing other duties as assigned. The Data Analyst will perform work at an advanced level by assisting with investigations of crimes related to the medical programs of the state. They will be responsible for the collection, compilation and analysis of information obtained from databases, source documents, medical and financial data, and other relevant sources. They will gather data from various databases and sources such as earnings information, medical billing data, various licensure statuses, participant eligibility in federal healthcare programs, business records, timecards, financial records, and social service information. They will be able to compile source data into a usable format for examination and/or investigation. They will analyze Medicaid billing data to identify trends and anomalies that may support or define allegations of fraud, as well as organize results and create memos or reports outlining findings and conclusions. They will present their findings to the Chief Forensic Auditor, assist in the interpretation and presentation of findings, and may be required to testify in court. The Data Analyst may also be required to prepare visualizations or presentations of their analysis utilizing excel, tableau, power BI, and other analytical software. The ideal applicant will be able to transform complex data and analyses into clear, concise actionable insights.
The Selected Applicant shall complete necessary training as required by federal, state, department and unit policies and must be able to communicate clearly and effectively in verbal and written form with others.

Requirements

Qualified applicants must possess good judgement and experience demonstrating the following:

• Exhibit proficient computer skills to utilize case management systems and other computer databases.
• Experience utilizing Microsoft Excel functions to manipulate large data sets by means of aggregating, grouping, sorting, and filtering.
• Experience analyzing large and complex data sets to identify trends/patterns.

Minimum Qualifications

The applicant must have graduated from an accredited college or university with a bachelor’s degree with a minimum of twelve semester hours or equivalent in accounting, business administration or finance, and eighteen months of full-time professional auditing or analytical experience. Consideration will be given to work experience in auditing or analytical work involving preparation of financial statements or analysis of financial data.