PAY GRADE: 020
CLASS TITLE:MEDICAID FRAUD ANALYST II
ALLOCATION FACTOR(S)
This is independent work conducting detailed research and analysis of investigative information relating to alleged criminal violations of applicable laws pertaining to provider fraud in the administration of the Medicaid program and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program. An employee in this position may perform as lead analyst on specialized complex analytical projects or criminal investigations.
EXAMPLES OF WORK PERFORMED:
(Note: The examples of work as listed in this class specification are not necessarily descriptive of any one position in the class. The omission of specific statements does not preclude management from assigning specific duties not listed herein if such duties are a logical assignment to the position. Examples of work performed are not to be used for allocation purposes.)
- Assists and supports Medicaid fraud investigators in the compilation and analysis of investigative information.
- Requests and receives information of a confidential nature.
- Obtains and analyzes Medicaid statistical data.
- Analyzes patterns and trends emerging from information developed during criminal investigations.
- Prepares reports pertaining to all aspects of the investigation for use in criminal prosecution, civil actions and administrative referrals.
- Assists in the prosecution of Medicaid fraud and/or patient abuse to include testimony in courts of law pertaining to the investigation.
- Prepares for and assists in providing in-service training to Medicaid Fraud Analysts I.
- Performs related work as required.
KNOWLEDGE, SKILLS AND ABILITIES:
(Note: The knowledge, skills and abilities (KSA's) identified in this class specification represent those needed to perform the duties of this class. Additional knowledge, skills and abilities may be applicable for individual positions in the employing agency.)
- Knowledge of report writing techniques.
- Knowledge of research and intelligence analysis techniques.
- Knowledge of the procedures and techniques for effective communication.
- Ability to organize data into logical format for presentation in reports, documents and other written materials.
- Ability to analyze, interpret and summarize criminal investigative data.
- Ability to review large amounts of data and to determine the significance, completeness and usefulness of the data.
- Ability to write reports, investigative summaries and memoranda resulting from information analysis.
- Ability to make independent decisions.
- Ability to report information clearly, concisely and accurately.
- Ability to plan, organize and coordinate work assignments.
- Ability to communicate effectively.
- Ability to establish and maintain effective working relationships with others.
MINIMUM QUALIFICATIONS
- A bachelor's degree from an accredited college or university and one year of professional experience in research, investigations, investigative analysis or statistics.
- Professional or nonprofessional experience as described above can substitute on a year-for-year basis for the required college education.
EFFECTIVE:
7/1/2001
HISTORY: