Get The Yulys App

Research Specialist III

The Targeted Query (TQ) Research Specialist (Research Specialist III) performs advanced queries and research related to Medicaid program data in the Office of Inspector General (OIG) Data Reviews directorate. The position reports and works under the direction of the OIG Data Reviews unit and performs advanced technical research utilizing multiple data sources, performs in-depth comparative analysis of Medicaid policies and paid claims data encompassing multiple program areas to identify, deter, and prevent potential fraud, waste, and abuse in the Medicaid program. The position is responsible for developing, designing, planning, conducting, and coordinating theoretical studies to validate and test provider compliance with published Medicaid policies, rules, and regulations. The TQ Research Specialist utilizes data mining expertise and conducts computer-based analytical research designed to isolate trends and patterns of potential aberrant provider billing activity or schemes; and uses a variety of advanced statistical methodologies to evaluate outcomes. The TQ Research Specialist reviews and responds to legislation, state and federal regulations, and policies and procedures impacting Medicaid and Data Reviews. The position serves as a research consultant to vendors, Office of Attorney General Medicaid Fraud Control Unit, OIG staff, and other state and federal agency staff. Works with a team of research specialists to analyze, establish, recommend, and update procedures for data analysis to improve existing computer-generated reports used in the identification of inappropriately paid claims and/or policy violations. The TQ Research Specialist may consult with other OIG staff regarding projects, planning, design, data collection, and subject selection for review. The position uses independent judgment and exercises extensive latitude to design, conduct, and evaluate research work products. The position may train and assist other Data Reviews staff in the use of computer applications, research methodologies, project development, and in the identification of resources necessary to produce effective outcomes. Serves as a senior-level researcher with minimal supervision and extensive use of independent judgment. The position will perform other duties as assigned. The position requires up to 10% travel with infrequent overnight stays. May require work hours other than 8 a.m. to 5 p.m. Requires viewing computer screens for long periods of time, up to six or more hours per day.

Essential Job Functions:
1. Performs advanced technical research and in-depth comparative analysis of Medicaid policies and paid claims data to identify, deter, and prevent potential fraud, waste, and abuse in the Medicaid program. (35%)
2. Responsible for developing, designing, planning, and conducting and coordinating theoretical studies to validate and test provider compliance with published Medicaid policies, rules, and regulations. Uses data mining expertise and conducts computer based analytical research designed to isolate trends and patterns of potential aberrant provider billing activity or schemes. Uses a variety of advanced statistical methodologies to evaluate outcomes. Leads teams to analyze, establish, recommend, and update procedures for data analysis to improve existing computer-generated reports used in the identification of inappropriately paid claims and/or policy violations. (25%)

3. Serves as a research consultant to vendors, Office of Attorney General Medicaid Fraud Control Unit, other OIG staff, and other state and federal agency staff. Consults other OIG staff regarding projects and in planning, designing, conducting data collection, and identifying subject selection for review. (20%)

4. Reviews and responds to inquiries regarding legislation, state and federal regulations, and policies and procedures impacting Medicaid and OIG. (15%)

5. Attends work on a regular and predictable schedule in accordance with agency leave policy. Participates in OIG special projects and other work as assigned. Keeps manager informed as required or as necessary. (5%)

Knowledge Skills Abilities:
Knowledge of local, state, and federal laws and regulations relevant to Medicaid and CHIP. Knowledge of statistical concepts and methods and their application to research analysis. Knowledge of measurement, testing, and evaluation of data. Knowledge of research methods, principles, techniques, and philosophies. Knowledge of systems and procedures used to evaluate project performance. Ability to plan, organize, and coordinate research projects. Ability to evaluate research data. Ability to ensure development of measuring instruments with respect to reliability, relevance, and validity. Ability to interpret and publish research findings. Ability to communicate effectively, both orally and in writing. Ability to coordinate activities among public, private, and professional groups, express ideas clearly and concisely, address audiences effectively, and exercise judgment in evaluating situations and making decisions. Skill in conducting qualitative and quantitative research. Skill in the use of a computer and the use of statistical and evaluative software, tools, and programs. Skill in the use of Microsoft Outlook, Word, Excel, and PowerPoint. Skill in researching, developing and writing professional reports and/or presentation material. Skill in problem solving and independent decision making. Skill in leading staff work processes, setting priorities, and monitoring progress. Skill in developing and evaluating policies and procedures; assessing risks and developing contingency plans; and making recommendations. Skill in synthesizing complicated and technical information and translating it into understandable and concise documents and presentations. Skill in interpersonal relationships, including the ability to work with people under pressure, negotiate among multiple parties, resolve conflicts, and establish and maintain effective working relationships.

Registration or Licensure Requirements:
None

Initial Selection Criteria:
a. Graduation from an accredited four-year college or university with a degree in public administration, computer science, statistical analysis, research methodology, management, business, or related field is preferred. Experience and education may be substituted for one another.
b. Experience in healthcare, Medicaid, or other health and human services programs is preferred.
c. Texas Medicaid Managed Care experience is preferred.
d. Experience in Microsoft Office is preferred.

Additional Information:


HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

MOS Code:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to: 35F, IT, 23, 02111, 8E000. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Top 10 Tips for Success when Applying to Jobs at HHSC and DSHS

Looking for more jobs near me. Find your favorite job now by visiting our jobs page.