Job Information
HEALTH AND HUMAN SERVICES COMMISSION Senior Research Specialist in Austin, Texas
Job/Position DescriptionThe Fraud Analytics (FA) unit within the Data Reviews Division of the Office of Inspector General (OIG) is seeking a Senior Research Specialist (Research Specialist IV) to expand the teamand#146;s research capacity. The Fraud Analytics unit is responsible for performing innovative data analytics that seek to maximize the identification of fraud, waste, and abuse (FWA) in state health and human services programs such as Medicaid (including Managed Care), CHIP, SNAP and TANF by providing data-driven insights that inform investigations, reviews, audits, and inspections. The Research Specialist will perform research and analysis that support this effort by enhancing Fraud Analyticsand#146; ability to leverage complex healthcare data and advanced analytics to effectively identify FWA. The FA Research Specialist oversees complex project development, conducts thorough policy and data research, and produces clear deliverables and reports. This position reports to the Director of Fraud Analytics and works under limited supervision, with significant latitude for the use of initiative and independent judgment. This position works closely with Fraud Analytics team members, internal OIG units, and external entities, and may provide guidance to others.The FA Research Specialist is responsible for developing and reviewing policies and procedures used in conducting and administering research activities, establishing quality assurance procedures, conducting quality assurance reviews on research projects, and consulting and providing technical advice on research methods and techniques. This position serves as a subject matter expert in health and human services program data and healthcare FWA schemes and scenarios. The position prepares written project plans, including objectives, scope, and methodology; prepares presentations and research findings; and assists with validation of research outcomes through data analysis and evaluation. Outcomes that support and/or directly inform work of FA data analysts and data scientists will advance team objectives by facilitating new FWA lead generation resulting from the augmentation of existing detection strategies and the development and deployment of novel strategies. * This position can telework 100% from any OIG location within Texas consistent with HHS telework policies. *Essential Job FunctionsAttends work on a regular and predictable schedule in accordance with agency leave policy and performs duties as assigned:1. Conducts complex and thorough policy research, data analysis, and evidence gathering activities to determine potential violations of program laws, rules, regulations, and acceptable industry practices. Assists with gathering and interpreting relevant program laws, regulations, and requirements; agency policies, procedures, and systems; and medical coding practices. Identifies inconsistencies and assists with obtaining expert and legal clarification. Suggests opportunities to enhance or clarify policy or procedures to improve outcomes and prevent fraud, waste, and abuse. (30%)2. Reviews data and conducts quality assurance activities to validate observable trends, outliers, or other patterns of behavior that may represent violations of Medicaid or other state health and human services program requirements. Analyzes complex medical and claims data to compare patterns of behavior with policy research. Proactively reviews available research, collaborates with peers, and monitors internal and external sources to ide https://jobshrportal.hhsc.state.tx.us/ENG/CareerPortal/job_profile.cfm?szOrderID=602093 Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.
