The Medicaid Fraud Division of the Office of the State Comptroller, formerly the Office of the Medicaid Inspector General, is currently hiring. If you are interested in employment opportunities with the Medicaid Fraud Division, please submit a resume to the attention of: Niki A. Trunk, Deputy Chief of Staff, Office of the State Comptroller, PO Box 024, Trenton, NJ 08625-025 or niki.trunk@osc.state.nj.us. The Division is currently seeking to hire for the positions listed below

The Data Mining Unit within the Medicaid Fraud Division is seeking a Medical Review Analyst.  The unit primarily works with Medicaid claims data to identify indicators or patterns of potentially fraudulent, abusive or wasteful behavior on the part of Medicaid providers and recipients.  The unit is responsible to run the SURS (Surveillance and Utilization Review Subsystem) program which is an exception-based, post-payment review process.  This program provides the tool to identify providers with aberrant patterns of practice and recipients whose use of Medicaid services is questionable.  The unit reviews these outliers and makes recommendations to correct the problem.  In addition to the SURS function, the unit are responsible to run reports requested by Division staff and other governmental staff.

The analyst's duties will include:  developing, reviewing and analyzing reports; conducting reviews of provider and recipient utilization patterns; assisting in formulating parameters for algorithms, applying valid sampling techniques and analytical methods; identifying trends in data; developing databases; designing output formats with more complex reporting; and researching healthcare issues for reporting. Requirements include a Bachelor's degree, more than three years related work experience including strong computer skills (ability to use Word, Excel, and Access databases), ability to use and understand statistics, and programming skills.  Medical billing experience preferred but not required.

The Special Investigations Unit within the Medicaid Fraud Division is seeking a candidate for the position of Medical Review Analyst.  The unit's primary responsibilities consist of conducting criminal background checks, performing on-site location reviews, interviewing Medicaid providers and recipients, as well as, testifying in administrative law proceedings.

The Medical Review Analyst duties will include, but not limited to, developing and analyzing claims data reports, conducting reviews of provider and recipient reports, in addition to, preparing written reports of investigative findings.  The analyst will also testify in court at administrative hearings, grand jury and trial. 

The ideal candidate will have a bachelor's degree, a minimum of three years of experience conducting pharmacy invoice audits and site reviews, along with possessing an in-depth knowledge of the applicable laws, statutes and regulations governing New Jersey pharmacies.  The candidate for this position will also be required to have strong analytical and computer skills that include a working knowledge of the Microsoft Word, Excel and Access packages.  Prior clinical experience as a pharmacist or pharmacy technician is encouraged.

Under the supervision of the Division Directors, the Regulatory Officer participates in investigations, conducts depositions with the purpose of ferreting out fraud and abuse in the Medicaid and NJ Family Care programs, handles matters litigated before federal and state courts and the Office of the Administrative Law, advises the agency on policies and procedures with respect to the application of federal and state law, reviews state and federal legislation, and regulations, proposed or enacted, affecting the agency, and researches issues affecting the agency.  Graduation from an accredited law school with a Juris Doctor (J.D.) Degree is required.  Two years experience as an attorney is required with experience in civil litigation preferred.   

Staff auditor will conduct audits of both providers and recipients, draft audit plans, organize audit work plans, draft audit reports, and provide oral reports to providers and recipients. Requirements include bachelor’s degree from a four year accredited college or university and/or a valid certificate as a Certified Public Accountant, four years of professional auditing and/or accounting experience, and experience in auditing or preparing cost reports, particularly for acute care or long-term care facilities.