Dental Investigator

About the position

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.

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.

Requirements

• Excellent verbal and written communication skills.
• Ability to interpret and apply rules, regulations, standards and policies regarding dental providers.
• Excellent time management and organizational skills.
• Proven ability to research and analyze data and information.
• Ability to establish and maintain effective working relationships with the public and department staff.
• Ability to work independently with minimum supervision.
• Bachelor's degree in a discipline relative to the program area from an appropriately accredited institution and four years of related experience; or an equivalent combination of education and experience.

Nice-to-haves

• Program Integrity and/or investigations experience.
• Experience working in a federally funded healthcare program.

Benefits

• Health insurance coverage under the High Deductible Health Plan (HDHP) for temporary employees who work an annual average of 30 or more hours per week.