Director of Health Care Division FY 2023.015

Website MassOIG Massachusetts Office of the Inspector General

About the Office of the Inspector General (OIG)

Since its creation as the first state-level inspector’s general office in the country, the Office has been at the forefront of promoting effective government and the responsible use of public money and property. The OIG is an independent agency charged with preventing and detecting fraud, waste and abuse in the use of public funds and public property. By statute, the inspector general has broad authority to oversee the use of state, local and federal funds by state and local governments, as well as by those who receive government funds or use public property. This includes state agencies, counties, cities, towns, quasi-governmental authorities, and districts, as well as individuals, corporations and not-for-profit organizations that do business with the government.

The Office is led by the Inspector General of the Commonwealth, who {…shall be appointed by the Governor, Attorney General and Auditor} “…solely on the basis of integrity and demonstrated ability in accounting, auditing, financial analysis, law, management analysis, public administration, investigation or criminal justice administration.” (MGL, Chapter 12A, Section 2.)

The Office is organized into nine business units, operates from two locations, employs approximately 80 staff, and an annual budget of over $9M.  Additional information about the office may be found Welcome to the Office of the Inspector General | Mass.gov.

The OIG enabling statute is MGL, Chapter 12A. Further details may be found at Chapter 12A (malegislature.gov).

The Health Care Division

Under the authority of the Office of the Inspector General (OIG), as enumerated within MGL, Chapter 12A, and various other statutes, including a separate annual authorization (see Section 161 of Chapter 126 of the Acts of 2022), the Health Care Division (HCD) has the charge to review, analyze, comment on, report on and otherwise opine on a variety of health care policy, delivery and access issues, including matters related to practices in hospitals, free care, services, service delivery, billing, the Medicaid program and potential or actual instances of fraud, waste or abuse. Based upon the OIG’s unique role within state government the work of the HCD and its reporting provides an important and direct platform to reach governmental leaders, including those serving in Legislative and Executive roles, and to thought and opinion leaders. While a study and report are scheduled to be issued each March, and are a major focus of the annual work, the HCD also has the opportunity and ability to direct and collaborate on a host of other health care-related projects.

The HCD is led by a director who leads a team of individuals, including health care specialists, policy analysts and investigators.  The director also has the ability to partner with other business units within the OIG and has access to information from across government.

While the HCD regularly reviews the Health Safety Net (HSN) and Medicaid programs, which are administered by the Office of Medicaid (MassHealth), its authority and reach allows for a broad spectrum for its work and focus.

The deliverables may include reports, letters, draft legislative changes, case referrals and/or other tools and methods for the OIG to share its findings, advance legislative or regulatory changes and/or advance investigative cases to the proper prosecutorial office.

While much of the work is done by OIG staff, there are opportunities to collaborate with and communicate among leaders across a host of health care-related agencies and departments within state government, including MassHealth, the Attorney General’s Medicaid Fraud Division, Health Policy Commission, CHIA, the Massachusetts Health Connector Authority, the Office of the State Auditor, and various Legislative Committees.

Responsibilities include:

  • Assisting team members with analyses and drawing conclusions using multiple forms of evidence.
  • Managing relationships with external entities, such as MassHealth.
  • Managing contracts; managing a budget; setting and meeting deadlines; and evaluating staff members.
  • Synthesizing complex theories and concepts into easily understood reports, studies, memos, correspondence and other communications.
  • Meeting deadlines and complying with detailed requirements and obligations.
  • Overseeing multiple projects at the same time, ideally planning projects on a two-year cycle.
  • Overseeing development of the Division’s annual report.

Key abilities, skills, and experience:

  • Must be knowledgeable about Medicaid policy, guidance and regulations.
  • Auditing experience, especially related to the ability to identify requirements or criteria to be measured against and then assessing whether such criteria are being met, is a core skill for this role.
  • Experience reviewing and understanding statutes, regulations and policies.
  • Demonstrated understanding of health care concepts such as health care coding, compliance, billing and claims processing.
  • Experience with health care fraud detection and risk management.
  • Strong writing and editing skills and the ability to create clear and accurate reports that include evidence-based findings and sound, actionable recommendations.
  • Ability to execute a plan while also having the ability to address current circumstances and issues in a timely manner.
  • Experience preparing and conducting presentations of projects and findings, including the development of a power point deck, is valuable.
  • A high level of attention to detail, ability to manage competing priorities and problem solve to produce required deliverables.

Other valued abilities, skills and experience include:

  • Experience with MassHealth.
  • Certified Fraud or an Accredited Healthcare Fraud Investigator.
  • Bilingual abilities.

Salary Range: $110,000 to $120,000

How to Apply:

Submit cover letter and resume via email or by mail by February 8, 2023 and resumes will be reviewed on a rolling basis to:

Mary Beth Farrelly, Chief Financial Officer

Office of the Inspector General

One Ashburton Place, Room 1311

Boston, MA 02108

IGO-employment@mass.gov

Please Note: Because we value the health and safety of our employees, all Office employees (absent an approved medical or religious accommodation) must be fully vaccinated, including a booster, against COVID-19. Before their first day of work, the successful candidate will need to provide proof of full vaccination (two doses of the Pfizer or Moderna vaccine plus a booster dose of either or one dose of the Johnson and Johnson vaccine plus a booster dose of either the Pfizer or Moderna vaccine) or a request for a reasonable accommodation based on a valid medical or religious reason.

Diversity Officer:

Mary Beth Farrelly

The Office of the Inspector General is an Equal Opportunity Employer committed to creating and supporting a diverse and inclusive work and educational community that is free of all forms of discrimination. The Office does not tolerate discrimination or harassment on the basis of age, color, disability, gender identity, genetic information, national origin, parental status, political affiliation, race, religion, sex, sexual orientation or veteran status. The Office promotes access, inclusion, and diversity for all staff, believing that these qualities are foundational components of an outstanding working environment and in keeping with its mission. The Office actively seeks to increase the diversity of its workforce and is interested in candidates whose experience and qualifications support an ongoing commitment to this core qu

To apply for this job please visit www.mass.gov.