Medicaid Fraud Analyst I/II

Section:                                  Medicaid Fraud Control Section/Criminal Law Division

Class:                                      Medicaid Fraud Analyst I/II

Location:                                Harrisburg or Norristown

Telework:                               This position will report to the headquartered location a minimum of 2 days per week.  You may have the opportunity to telework the remainder of the week, if desired and based on business need.   

Position Type:                       Full-time, Non-civil service, Union

Work Hours:                          8:30 – 5:00      

Salary Range:                        Medicaid Fraud Analyst I - Pay Range 5:  Starting salary $44,890

                                                Medicaid Fraud Analyst II - Pay Range 7:  Starting salary $58,035

Basic Function

An employee in this position performs work which involves the retrieval, analysis, and compilation of data and the verification and dissemination of information pertinent to investigations into the Medicaid Fraud and Abuse amendments, the Neglect of Care-Dependent Persons Act, and other applicable State and Federal regulations.  The employee is responsible for assisting with/conducting the retrieval, compilation, and summarization of information needed by Special Agents in the course of an investigation.  Supervision is received from an investigative or administrative superior who reviews the work while in progress and upon completion.

• Assists with determining, or determines under the direction and guidance of an experienced analyst and/or supervisor, data requirements, sources, and parameters and gathers the needed information within the given time constraints using a variety of methods, inclusive of various computer programs
• Meets with appropriate personnel within the OAG or other governmental agencies to ascertain needs with respect to assignments
• Makes requests for pertinent documents needed for the analysis of referrals/intake complaints or pending information
• Contacts individuals to schedule meetings, and participates in the meetings, in order to gather needed data
• Assists with the preparation of, or prepares under the direction and guidance of an experienced analyst and/or supervisor, summarizations of data gathered by editing, compiling, and tabulating
• Provides assistance to agents relative to data checks, background checks, and claims histories
• Assists with the execution of search warrants for the purpose of cataloging data and documentary evidence
• Assists with the conduct of, or conducts under the direction and guidance of an experienced analyst and/or supervisor, various surveys of limited scope when an assignment requires such and prepares reports of findings
• Prepares spreadsheets, charts, and graphs
• Assists with the review of, or reviews under the direction and guidance of an experienced analyst and/or supervisor, computer printouts, vouchers, or other documents to ascertain the needed data
• Provides litigation support through the preparation and presentation of material/evidence for official proceedings/court
• Testifies in court proceedings and grand jury proceedings regarding analytical findings. Inputs data into computer system by utilizing a computer keyboard
• Performs other duties as assigned

Qualifications for Medicaid Fraud Analyst I are as follows:

• A Bachelor’s Degree from an accredited institution OR
• Graduation from high school and four years of relevant experience that would afford the individual the needed knowledge and skills to perform the job OR
• Any equivalent combination of education, training, and experience that would enable the individual to perform the duties of the job

Qualifications for Medicaid Fraud Analyst II are as follows:

• A Bachelor’s Degree from an accredited institution and two years of relevant experience that would afford the individual the needed knowledge and skills to perform the job OR
• A Master’s Degree in criminal justice or a related field OR
• Graduation from high school and six years of relevant experience that would afford the individual the needed knowledge and skills to perform the job OR
• Any equivalent combination of education, training and experience that would enable the individual to perform the duties of the job

• Knowledge of Microsoft Excel (advanced)
• Experience using Pivot Tables
• Possess excellent oral and written communication skills and be able to communicate with employees throughout all levels of the organization
• Ability to work both independently and in a team environment