MEDICAL CARE PROGRAM SPECIALIST II

GRADE

STD0016

LOCATION OF POSITION

MDH Office of the Inspector General for Health\r\nBaltimore, MD 21201\r\n

Main Purpose of Job

The Maryland Office of the Inspector General for Health (OIGH) is charged with investigating fraud, waste, and abuse (FWA) within the Medicaid Program and seeking the recovery of inappropriate payments across both provider and recipient fraud lines. Operating as a Regulatory Compliance Investigator within the Program Integrity – Recipient Reviews Unit, this position utilizes target-centric fraud-detection methodologies to actively determine if Medicaid beneficiaries are eligible for services and truthful in their application for benefits. The incumbent performs the full range of audits and investigations across Maryland’s population of approximately 1.1 million Medicaid recipients.\r\nThis position is responsible for performing objective 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. The investigator 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.\r\nThese 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 formal report with enforceable recommendations, which may include benefit adjustments, financial recoveries, and referral for civil or criminal fraud prosecutions.\r\n

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.\r\n\r\n\r\nNotes:\r\n\r\n\r\n1. 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.\r\n\r\n\r\n2. 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.\r\n\r\n\r\n3.�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.\r\n\r\n

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:\r\n\r\n\r\n Experience determining Medicaid eligibility, including experience working with Medicaid policies and procedures.\r\n Experience accessing the Maryland Health Connection website to retrieve information and documents.\r\n Experience interviewing subjects to pertinent elicit information.\r\n Experience researching government websites, social media, and other public websites to access and retrieve information.\r\n Experience drafting letters and investigative reports.\r\n Experience using Google Drive and spreadsheets.\r\n\r\n\r\n

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.\r\n

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).�\r\nComplete applications must be submitted by the closing date.�Information submitted after this date will not be added.�\r\nIncorrect application forms will not be accepted.�Resumes will not be accepted in lieu of a completed application.\r\nCandidates 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.\r\n

BENEFITS

STATE OF MARYLAND BENEFITS\r\n

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.\r\nIf 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.\r\nFor questions regarding this recruitment, please contact the�MDH Recruitment and Selection Division at 410-767-1251.\r\nIf 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.�\r\nAppropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.\r\nWe thank our Veterans for their service to our country.\r\nPeople with disabilities and bilingual candidates are encouraged to apply.\r\nAs an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.\r\n