Fraud Unit Supervisor (WMS2/DAIO)

Fraud Unit Supervisor (WMS2/DAIO)The Fraud Unit Supervisor serves as the agency subject matter expert in identifying, detecting, investigating, and reporting suspected cases of fraud, waste, and abuse in our state and federally funded health care programs. The ideal candidate will understand the legal framework and laws governing their work as well as understanding the sensitivity of fraud and relationships necessary to achieve their goals. If you are motivated to jump into a new position with the opportunity to create processes and systems that address fraud, waste, and abuse across the state, this may be the position for you.All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.About the unit:The Office of Regulatory Compliance & Oversight (ORCO) is part of the Division of Audit, Integrity, and Oversight (DAIO) of the Health Care Authority (HCA). ORCO provides technical assistance, resources, and oversight functions to federal and state grants, subawards, and state Medicaid expenditures. ORCO provides leadership, education, and support to all divisions of the agency at all employee levels to mitigate risks, comply with changing laws, and assist the agency in accomplishing its goals.About the position:This position will be enhancing and establishing processes for prevention, detection, and mitigation of fraud, waste, and abuse in state and federally funded health care programs. This individual will establish strong relationships, improve processes, and manage staff performing this work.This position is responsible for managing the workload of the unit and for facilitating coordination between HCA, managed care organizations (MCOs), the Department of Social and Health Services, the Department of Children, Youth, and Families, the Department of Health, and the Medicaid Fraud Control Unit to determine legally defensible action paths for all allegations of fraud, waste, and abuse in our medical programs. This position is further responsible for assisting in developing and maintaining all agency policies and procedures relating to fraud, waste, and abuse for Medicaid, grant, and state funded activities.This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.Some of what you will do:• Supervises a unit of professional staff responsible for establishing and implementing effective processes and internal controls for intake, investigation, referral, and tracking for all allegations of fraud, waste, and abuse in HCA programs.• Develops processes that accurately meet conditions prescribed by state and federal law and regulation regarding fraud, waste, and abuse.• Conducts and oversees comprehensive external fraud investigations associated with provider billing practices using mechanisms such as data mining and other fraud detection tools.• Provides tactical and strategic leadership and direction on HCA’s response to allegations of fraud, waste, and abuse in HCA medical programs.• Recommends improvements to workflows and strategies to assist staff and leadership in conducting investigations and making decisions on referrals.• Trains and mentors fraud investigators and others involved in the fraud, waste, and abuse processes.• Builds and maintains good relationships with internal and external partners and law enforcement agencies.• Collects and analyzes fraud data to understand and consult on external fraud patterns and trends.• Compiles, prepares, enters, and updates records, data, reports, and other information in program database files, and other storage media repositories.• Supports relationships with sibling agencies, MCOs, and MFCU to maintain statewide referral partnerships.• In partnership with the Program Integrity Liaison, oversees fraud mitigation efforts internally and externally with sibling agencies and managed care organizations.• Develops, maintains, and updates fraud related policies and standards, ensuring alignment within regulatory requirements and industry best practices.• Analyzes bills and legislation as they pertain to program integrity matters and informs executive leadership of any potential benefits or challenges from proposed legislation.• Assembles evidence and documentation to support successful adjudication.Required qualifications:Qualifying candidates will satisfy one of the follow qualification options:Option 1:• Nine years of advanced expert level experience in conducting fraud, waste, and abuse investigations in the healthcare field.Option 2:• Associate degree involving major study in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics or closely allied field and• Seven years of advanced expert level experience in conducting fraud, waste, and abuse investigations in the healthcare field.Option 3:• Bachelor's degree involving major study in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics or closely allied field and• Five years of advanced expert level experience in conducting fraud, waste, and abuse investigations in the healthcare field.Option 4:• Master's degree involving major study in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics or closely allied field and• Three years of advanced expert level experience in conducting fraud, waste, and abuse investigations in the healthcare field.Option 5:• A law degree from an accredited college or university approved by the Washington State Bar Association and• Three years of advanced expert level experience in conducting fraud, waste, and abuse investigations in the healthcare field.Preferred qualifications:• Knowledge of healthcare payment methodologies.• Demonstrated experience in innovation and establishing programs and policies.• Inquisitive nature with ability to analyze data.• Experience working with Medicaid or the behavioral health industry.• A law degree from an accredited college or university approved by the Washington State Bar Association.• Demonstrated ability to problem-solve, prioritize workloads, meet deadlines, and provide independent strategic direction/decision making.• Meets commitments, works independently, accepts accountability, and stays focused under pressure.• Deals with others in a straightforward and honest manner, is accountable for actions, maintains confidentiality, and supports agency values.• Gives the appropriate attention to detail and accuracy, has a commitment to excellence, strives for continuous quality improvement.• Supervisory experience including conducting employee performance reviews.• Ability to clearly communicate complex information, verbally and in writing to a non-technical audience.• Excellent interpersonal skills.How to apply:Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach:• A cover letter that specifically addresses how you meet the qualifications for this position• Current resumeTo take advantage of veteran preference, please do the following:• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.About HCA:Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.What we have to offer:• Meaningful work with friendly co-workers who care about those we serve Voices of HCA• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values• A healthy work/life balance, including alternative/flexible schedules and mobile work options.• A great total compensation and benefit package WA State Government Benefits• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.• Tuition reimbursement• And free parking!Notes:Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at jake.nelko@hca.wa.gov or 360.725.0945.The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.E-Verify® is a registered trademark of the U.S. Department of Homeland Security.Subscribe to our weekly newsletter to receive a list of new job postings at HCA.