Job/Position DescriptionThis position is housed within the Provider Field Investigations (PFI), Medicaid Program Integrity unit of the Investigations and Utilization Reviews (IandUR) division of the Office of Inspector General (OIG) and reports directly to a PFI Manager. Performs 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 and data analysis, and the development of complex investigative reports. Work involves up to 25% statewide travel, which includes some overnight travel. The investigator works under limited supervision of the PFI Manager with considerable latitude for the use of initiative and independent judgment.* 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 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 Researches, reviews, and investigates 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 associated with investigations in conformity with applicable PFI policies and procedures, including but not limited to case-specific deadlines assigned by management. Obtains approval from Deputy Inspector General for MPI or designee to complete no fewer than five full-scale investigations per year. Gathers, analyzes, and interprets business, financial, and medical documentation. (35%)Evaluates, summarizes, and communicates investigative findings through various oral and 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%)Conducts interviews with recipients, witnesses, providers, complainants, and providerand#146;s staff regarding investigations. (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%)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. (15%)Makes consultative visits and establishes liaisons with the Attorney Generaland#146;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 tr https://jobshrportal.hhsc.state.tx.us/ENG/CareerPortal/job_profile.cfm?szOrderID=604997 Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.