Managed Care Oversight Investigator I

ncwildlife.gov

Unknown, Unknown, US
Recruitment range: $50,633 - $63,500; salary grade...
Hybrid
Medicaid provider network investigations
Analyze member and provider data
Review operational manuals for compliance
The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network

Job Summary

  • The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network.
  • This role supports the integrity of state healthcare expenditures and promotes program compliance.
  • The State of North Carolina offers excellent comprehensive benefits, including health insurance, retirement plans, and paid leave.

Matching Summary

The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network.

Salary

Recruitment Range: $50,633 - $63,500; Salary Grade Range: $52,592 - $92,036; Benefits: Comprehensive state benefits package

Skills & Requirements

Must-have

  • Medicaid provider network investigations
  • Analyze member and provider data
  • Review operational manuals for compliance
  • Investigate provider billing and claims
  • Conduct provider investigations

Nice-to-have

  • Collaborate with internal teams and external stakeholders
  • Provide direct feedback to managed care organizations
  • Experience with investigative audits and reporting

Key Requirements

  • Master's degree and two years of related experience OR Bachelor's degree and four years of related experience OR equivalent combination
  • Working knowledge of Medicaid program objectives, clinical billing, medical coding, documentation standards, and state/federal regulatory requirements
  • Ability to interpret and apply state and federal regulations, managed care contracts, provider standards, and program policies
  • Skilled in data collection, analysis, program evaluation, quality assurance, investigative techniques, and conducting audits and documentation reviews
  • Effective communicator with experience explaining policy, delivering training, and collaborating with agencies, providers, and diverse stakeholder groups

Work Rights

Not specified

Tailored Resume

Cover Letter