Fraud Investigator

Incumbent serves as fraud investigator within the Department of Child Services Administrative Services group.

Formulates, interprets, compiles and disseminates, to applicable agencies and groups, all policies and procedures related to the personnel review and any other investigation;

Serves as a liaison between contracted agencies and other DCS stakeholders concerning investigations;

Performs related tasks as required.

Establishes effective communication of investigation status to all necessary DCS program areas.

Provides professional, timely, and effective customer service to contract related internal and external customers.

Responsible for reviewing, comparing, and compiling findings from provider reported documentation in exceptionally large quantities that are submitted as part of a simultaneous statewide review of all providers holding the contract types listed above.

Assure providers and their employees meet established quality levels of service and billing that conform to requirements set out by DCS and other review agencies by conducting contract compliance audits.

Maintains full knowledge of all ten contracts, service standards, DCS policy, PLA policy, DMHA policy, FSSA policy and policies surrounding grants to assure providers are adhering to service and financial guidelines.

Assure contract compliance is met with subcontractors of contracted DCS providers.

Assure DCS providers are providing supervision and assuring adherence to DCS contracts by their subcontractors.

Develop and maintain provider data within an access database.

Develop and maintain excel spreadsheets and reports for comparison of provider data.

Conduct yearly statewide contract compliance reviews of multiple DCS provider contracts to ensure compliance with Service Standards and to determine whether appropriate documentation exists to support the claim for service.

Gathers and analyzes data, prepares data summarizes, reports findings, interprets results and/or makes recommendations regarding contract compliance/performance reviews.

Adheres to a multiple point audit process and evaluates documentation and employee data assuring it is consistent and accurate. This includes but is not limited to quality control measures that are evaluated by the supervisor.

Understands and adheres to the timeframe of each phase of the audit process. Assures audit processes are completed for each phase within acceptable timeframes in order to begin facilitation of following phases of review

Reviews audit results with management to determine actions needed.

Writes or drafts correspondence, reports, documents, and/or other written materials.

Monitors completed audits for completion of audit findings, including payment of monies due to the state.

Develops reports and collaborates with supervisor to establish parameters of prosecutable fraud by county.

Reports recommendations to supervisor for follow-up with the Inspector General's office and Attorney General's office for prosecution of fraud.

Other duties as assigned.

Required/Desired Skills Skill Required /Desired Amount of Experience Working knowledge of accounting and auditing principles. Required 1 Years Extensive knowledge of all source materials and references including federal and state laws governing the programs. Required 1 Years Understanding of principles, theories and practices of program audits. Required 1 Years Ability to develop and implement new principles and policies and discern any far reaching implications regarding vendors or program areas. Required 1 Years Ability to comprehend, analyze, interpret and correlate very technical material. Required 1 Years Ability to use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions. Required 1 Years Ability to find, gather and collect information or data and evaluate information against a set of standards. Required 1 Years Ability to communicate information and ideas clearly and concisely, orally and in writing. Required 1 Years Ability to develop and implement new principles and policies and discern any far reaching implications regarding vendors or program areas. Required 1 Years Ability to research methods, techniques, and/or sources of information. Required 1 Years