Auditor I

The California Department of Justice is dedicated to fighting healthcare fraud and protecting the Medi-Cal Program. The Auditor I role involves conducting complex civil audits and investigations, analyzing claims data, and collaborating with various stakeholders to combat fraud and recover stolen funds.

Responsibilities

• 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

Skills

• Superlative data management and investigative skills
• Commitment to detecting and combating fraud
• Ability to conduct complex civil audits and investigations
• Experience working with auditors and attorneys from other state Medicaid Fraud Control Units and/or Federal Assistant United States Attorneys
• Ability to review and provide claims data of suspected activity and assist in civil remediation
• Ability to obtain and analyze information from Medi-Cal claims database(s) and other evidence
• Skill in identifying, gathering, and maintaining voluminous data relevant to allegations of fraud
• Ability to estimate and calculate monetary losses to the Medi-Cal program
• Experience determining the reasonableness of audit findings and evaluating results through comparative analysis and independent third-party verification
• Ability to conduct interviews and perform fieldwork needed for audits or investigations
• Skill in compiling and evaluating competent evidentiary material
• Ability to develop audit findings and prepare detailed reports of investigation and schedules of findings
• Experience participating in meetings, depositions, and interviews with various stakeholders
• Ability to develop forensic investigative strategies and identify necessary resources for audit and investigative assignments
• Experience collaborating with teams of attorneys, paralegals, support staff, investigators, agents, auditors, and other analysts
• Skill in 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
• Ability to assist in the preparation and service of subpoenas, as well as in the preparation of discovery requests and responses
• Experience assisting in the preparation of matters set for hearing, settlement, and trial, including testifying in civil hearings, depositions, and trials

Benefits

• Work-life balance
• 11 paid holidays
• Flexible paid leave options
• Consistent wage increases
• Pension retirement
• Job stability
• Health/Dental/Vision Insurance
• Public Service Loan Forgiveness (PSLF) and more!

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