DC Office of the Inspector General

Job Summary

This position is located in the Medicaid Fraud Control Unit (MFCU) within the District of Columbia’s Office of the Inspector General (OIG), an organization responsible for promoting the economy, efficiency, and effectiveness of, and preventing and detecting corruption, fraud, waste, abuse, and mismanagement in the District Government.  MFCU is charged with investigating and prosecuting (or referring for prosecution) violations of all applicable District or Federal criminal and civil statutes with respect to various healthcare fraud schemes involving Medicaid funds and providers; and abuse, neglect, or financial exploitation of Medicaid beneficiaries.

Duties include but are not limited to:

Provides audit support to assist investigators and attorneys in preparing healthcare fraud cases under investigation for criminal prosecution or civil litigation.
Reviews/analyzes healthcare provider records, billing claims, data sets, financial records, and other documents to determine potential healthcare overpayments or fraudulent billing for unnecessary services or services not rendered.
Prepares appropriate written reports, visualizations, and presentations to explain findings of healthcare analysis for various audiences; assists in presentations to other agencies, including investigative entities, and federal and local prosecutors; and testify or assist in legal proceedings as necessary.
Contributes to the achievement of established department goals and objectives; adheres to department policies, procedures, quality standards, and safety standards; and exercises day-to-day responsibility for ensuring production progress, quality control, and efficient use of time and resources.
Performs other related duties as assigned

Degree:  accounting, auditing, or a degree, including auditing courses in a related field such as business administration, finance, or public administration that included or was supplemented by 24 semester hours in accounting. The 24 hours may include up to 6 hours of credit in business law.

Applicants must have at least two (2) years of specialized experience equivalent in difficulty and complexity to the CS-11 grade level in the District of Columbia government service that has equipped the applicant with the particular knowledge, skill, and ability to perform successfully in this position. This experience may have been gained in a non-District of Columbia government service position. Examples of specialized experience include conducting studies to identify, analyze, and recommend solutions to problems in an organization.

Possess substantial knowledge of (GAAS) Generally Accepted Auditing   Standards, (GAAP) Generally Accepted Accounting Principles, analytic data techniques, methodology, and procedures, including but not limited to internal control review, analysis, and development, the General Accounting Office’s Government Auditing Standards, and standards of the American Institute of Certified Public Accountants and the Institute of Internal Auditors.

Licensures, Certifications and other requirements
Possess experience in Medical coding and Medicaid billing, CPT Codes (Current Procedural Terminology), HCPCS codes (Healthcare Procedure Coding System)  as set by the Medical American Association and their changes, general billing procedures for health care providers and institutions, Medicaid reimbursement guidelines.

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