Auditor

Interested in fighting healthcare fraud using your analytical and quantitative skills? Seeking to help recover stolen funds, protect the Medi-Cal Program against false claims submitted for payment to the State of California and help protect the vulnerable population? The Division of Medi-Cal Fraud and Elder Abuse is looking for talented auditors with superlative data management and investigative skills and a commitment to detecting and combating fraud – this is an opportunity highly qualified applicants should not miss.

• Conducts complex civil audits and investigations for the Civil Section, including:
  • Work with auditors and attorneys from other state Medicaid Fraud Control Units and/or Federal Assistant United States Attorneys to combat global health fraud. Review and provide claims data of suspected activity and assist in civil remediation.
  • Obtains and analyzes information from Medi-Cal claims database(s) and other evidence obtained from a variety of sources associated with cases and complaints of alleged Medi-Cal provider fraud.
  • Identifies, gathers, and maintains voluminous data relevant to such allegations.
  • Estimating and calculating monetary losses to the Medi-Cal program, including determining the reasonableness of audit findings and evaluating such results through comparative analysis and independent third-party verification.
  • Conducting interviews, performing any and all fieldwork needed for the audit or investigation, compiling and evaluating competent evidentiary material, developing audit findings, preparing detailed reports of investigation and schedules of findings that result from investigative activities and records examinations.
  • Participating in meetings, depositions, and interviews with qui tam relators, investigative, legal, and managerial staff, as well as private law firms and various governmental agencies.
  • Developing forensic investigative strategies and identifying resources necessary to perform various audit and investigative assignments.
  • Collaborating with teams of attorneys, paralegals, support staff, investigators, agents and auditors, and other analysts both within and beyond the Division.

• Utilizing computerized audit techniques with tools including MIS/DSS claims database, Business Objects, Medi-Cal Management Information System, Lexis-Nexis, Microsoft Office Suite, SAS Enterprise Guide to develop programs and other information for sampling, cost evaluations, determining patterns, and trend analysis.

• Assisting in the preparation (including drafting) and service of subpoenas, as well as in the preparation of discovery requests and discovery responses.

• Assisting in the preparation of matters set for hearing, settlement, and trial, including testifying in civil hearings, depositions, and trials both in person and by affidavit.

You will find additional information about the job in the Duty Statement.

Please access this link for information on benefits afforded to employees who work for the State of California -

• AUDITOR I
• INVESTIGATIVE AUDITOR II, DEPARTMENT OF JUSTICE
• INVESTIGATIVE AUDITOR III, DEPARTMENT OF JUSTICE
• INVESTIGATIVE AUDITOR IV (SPECIALIST), DEPARTMENT OF JUSTICE

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

• Experience and knowledge working with Medical Claims
• Experience in conducting complex financial and forensic audits and investigations, researching and interpreting complex rules and regulations, reviewing and analyzing accounting records and financial institution records, performing statistical analyses for large volumes of data, and testifying in court or administrative hearings
• Proficiency in generating work products and/or spreadsheets using Excel.
• Ability to write and produce concise, professional documents and reports, and to express facts and conclusions precisely and clearly
• Successful completion of college-level courses in elementary and intermediate accounting, auditing, and cost accounting, as well as statistics
• Ability to work under limited supervision on multiple assignments within a team environment
• Proactive in the identification and successful resolution of issues
• Regularly exercise the highest degree of professional judgment, integrity, and maturity

• Ability to work flexible, possibly extended hours, and to travel, as needed
• Experience working NAMFCU cases and prior experience working as a Global Case team member
• Proficiency using and SAS Enterprise Guide