Offer summary

Qualifications:

Relevant experience in dental investigations or healthcare compliance., Knowledge of Medicaid rules and regulations., Strong analytical and investigative skills., Ability to work independently in a hybrid/remote setting..

Key responsibilities:

Monitor dental provider compliance and vendor accountability.

Conduct investigations into dental fraud, waste, and abuse.

Ensure contract compliance through quality assurance reviews and reporting.

Analyze evidence, interview witnesses, and prepare investigative reports.

Job description

This is a temporary position and there are no leave or retirement benefits offered with this position. Temporary employees who work an annual average of 30 or more hours per week may be eligible for health insurance coverage under the High-Deductible Health Plan (HDHP). For more information on health benefits offered visit www.shpnc.org.

NOTE: If you are a current NC State Government employee, you will be considered for a temporary assignment. However, Temporary Solutions cannot accommodate dual employment.

This part-time temporary position is located in Raleigh, NC - Wake County.

Telework Availability

We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services (DHHS) offers work from home options and variable work schedule flexibility for this position.

The Division of Health Benefits (DHB) requires temporary workers with an approved hybrid telework schedule to work onsite at their assigned duty station at least 4 working days per month. More information on this arrangement may be obtained at the time of the interview.

Hourly Rate: $28.00 to $32.00

(Hourly Rates are based on education, experience, equity, and budget)

Position Overview

This is a temporary position within North Carolina Department of Health and Human Services (DHHS), Division of Health Benefits (DHB), NC Medicaid, Office of Compliance and Program Integrity (OCPI). OCPI is responsible for the detection and prevention of fraud, waste and abuse (FWA) in the delivery and cost of provider services and ensuring providers and managed care entities are in compliance with Medicaid rules and regulations. Functions and responsibilities for OCPI include compliance oversight of Medicaid health plans and contracted state vendors who conduct investigations of Medicaid FWA.

Job Specific Responsibilities

Monitor dental provider compliance and contracted state vendors program integrity accountability to prevent fraud, waste and abuse (FWA).
Conduct dental fraud, waste & abuse (FWA) investigations
Ensure compliance with contracts through quality assurance reviews and monthly reporting.
Provide compliance oversight and quality control of vendor FWA dental investigations
Conduct investigations via analyzing documents and evidence, interviewing witnesses and summarizing findings in written reports.
Perform other duties as assigned.

Required profile