Data Scientist (Financial Examiner 3), Medicaid Fraud Control Division, Olympia

 Persons requiring reasonable accommodation in the application process or requiring information in an alternative format may contact the recruitment team at HREmployment@atg.wa.gov. Those with a hearing impairment in need of accommodation are encouraged to contact the Washington Relay Service at 1-800-676-3777 or www.washingtonrelay.com.

Position and Salary:
 
The Attorney General’s Office is recruiting for a permanent full time Data Scientist in the Medicaid Fraud Control Division. This position is located in Olympia, Washington, and is represented by the Washington Federation of State Employees (WFSE).
 
Financial Examiner 3 Salary range 66: $78,468 - $105,612
The base pay offered will take into account internal equity and may vary depending on the preferred candidate’s job-related knowledge, skills, and experience.

The following stipends may apply based on position requirements:

• Incumbents assigned to our Seattle office location receive an additional 5% King County Location Pay stipend.  
• Incumbents assigned to a position designated as requiring dual language skills will receive a 5% Dual Language Requirement Pay stipend. 

The AGO provides a workplace that is understanding of work-life balance and promotes advancement by offering a wide variety of professional development and growth opportunities.

Excellent benefits:
 
Washington State offers one of the most competitive benefits packages in the nation, including Medical/Dental/Vision for employees & dependent(s); Vacation, Sick, and Other Leave; 11 Paid Holidays per year; Public Employees Retirement System (PERS) plans; and Life Insurance.  Beyond these traditional benefits, we offer Dependent Care Assistance, Flexible Spending Accounts, Public Service Loan Forgiveness, Tuition Waiver, Deferred Compensation, Employee Recognition Leave, and more. With the goal of employee health and wellness, we also offer:

• Flexible schedules and part-time/hybrid telework options;
• A Wellness Program, an Infants in the Workplace Program, and the Employee Assistance Program, which provides counseling, webinar, and other cost-free support resources;
• Numerous employee-driven affinity groups to foster community and connection, including Bereavement, Elder Care, Parenting, POC, LGBTQ+, Veterans and more. The AGO is a place to belong and make a difference!

About the Medicaid Control Division:

The work of the Office’s Medicaid Fraud Control Division (MFC) focuses on both criminal and civil law enforcement. The 75% federally funded MFC‘s mission is combating provider fraud, abuse and neglect in residential facilities and involving Medicaid recipients in non-institutional settings.

MFC’s Headquarters is located in Olympia, Washington with some team members also located at the AGO's Spokane Office and Seattle Office.  The Division currently has a staff of 64 FTEs, including attorneys, special agents, data scientists, clinical health investigators and professional support staff.

MFC involves protecting not only the Medicaid program of roughly 19.6 billion dollars per annum, but also its most vulnerable persons, typically elderly persons in residential facilities or persons abused or neglected by a Medicaid Provider.  In many of our cases, there is no precedent so MFC is consistently on the cutting edge of legal theories and issues.  The cases range from abuse and neglect of persons in nursing homes, large scale organized individual and corporate civil and criminal fraudulent activity to national whistleblower actions.  Our staff is a highly professional, fun and seasoned analytical investigative team.  MFC is unique in that all cases have an attorney, special agent, data analyst assigned with legal support.  This, and the great people who make up the division, gives MFC a particularly terrific team atmosphere.

Duties and Essential Functions of a Data Scientist: 

• Conduct investigative steps to identify, research and assess allegations of fraudulent billings and/or other issues. 
• Query and analyze complex healthcare service claim and encounter data to determine utilization of complaint/allegation, and respond to data requests.
• Examine, analyze and research financial and billing documents; audit documents, and healthcare records obtained during the intake process, and/or collected from search warrants and Civil Investigative Demands 
• Build concise and factual electronic investigative or analytical reports, spreadsheets and associated documents.  
• Maintain all reports, documents, spreadsheets, correspondence and other pertinent documentation in electronic format.
• Conduct audits of collected data and records.
• Understand and apply various billing regulations and policies, and medical coding systems to analyze complex healthcare data and records to identify billing and coding irregularities.
• Apply statistical analysis and utilize statistical methods to determine extend of fraud.
• Determine valid conclusions and develop appropriate recommendations.
• Assist with and participate in National Association of Medicaid Fraud Control Units (NAMFCU) cases, which includes but is not limited to responding to data requests, developing investigative strategies involving data, drafting data requests, developing damage models and performance calculations based on data received from other MFCUs. 
• Establish and maintain good working relationships with law enforcement and other local, state or federal agency staff; assist with investigations, audits, or other tasks as needed.
• Actively participate in and assist investigative teams.
• Prepare and present findings in the form of briefings and/or reports to the assigned investigative team and/or others. 
• Participate in victim and witness interviews. 
• Assist with search warrants and Civil Investigative Demands. 
• Participate and provide expert testimony at trial as requested. 

This recruitment announcement may be used to fill multiple open positions for the same classification, in addition to the position(s) listed in this announcement.

Qualifications: 

A Bachelor’s degree with major study in finance, business administration, economics, or accounting including at least 12 semester or 20 quarter hours of accounting, finance or economics

Plus

Three (3) years of professional experience in one of the following:

• Accounting or auditing
• Analyzing or examining regulated entities
• Working for a regulated entity in advanced positions in the areas of lending, operations, analysis of loan of securities portfolios, auditing, reinsurance, investments, information system reviews or any combination of these.

Additional qualifying experience may substitute year-for-year for required education.

Preferred Certification: Certified Public Accountant (CPA), Accredited Financial Examiner (AFE) or Certified Financial Examiner (CFE) 

SKILLS AND ABILITIES:

Prior experience analyzing healthcare claims data.

Basic skills and experience with Coding (CPT, HCPCS ICD9, ICD10),

Basic skills and experience with Microsoft Excel Microsoft Word, Microsoft Outlook, Microsoft Access; and experience with Adobe Acrobat, which includes converting Microsoft Office files to PDF files, 

Basic skills and experience knowledge of RAT-STATS, SQL, and PL/SQL Oracle,

Advanced experience working with large and complex data sets.

Experience with data visualization using Tableau, Power BI, and other similar visualization tools. 

CONDITIONS OF EMPLOYMENT:

A background check consisting of employment history, professional references and educational verification (e.g., degree, license, or official transcript) may be conducted. Prior to any offer, the applicant selected will be required to submit to and pass a fingerprint-based criminal background check conducted by the Washington State Patrol, Criminal Records Division. The incumbent will submit to additional background checks as a condition of employment every five (5) years thereafter.

About the Washington State Office of the Attorney General
 
 The Attorney General’s Office (AGO) touches the lives of every resident in this state.  We serve more than 230 state agencies, boards, commissions, colleges and universities, as well as the Legislature and the Governor.  The Office is comprised of nearly 700 attorneys and 800 professional staff, all working together to deliver the highest quality professional legal services to Washington state officials, agencies, and entities.  This includes: 

• Economic justice and consumer protections (safeguarding consumers, protecting youth, seniors, and other vulnerable populations)
• Social justice and civil rights (addressing discrimination, environmental protection, and veteran and military resources)
• Criminal justice and public safety (investigative and prosecutorial support, financial crimes)
• And much more!

Our agency also has national reach, representing the State of Washington before the Supreme Court, the Court of Appeals and trial courts in all cases that involve the state’s interest.  If you want to make a difference, we may be the perfect fit for you!   Learn more about the AGO here.  
 
Commitment to Diversity
 
Diversity is critical to the success of the mission of the AGO. This means recognizing, respecting, and appreciating all cultures and backgrounds-- and fostering the inclusion of differences between people.  Appreciating, valuing and implementing principles of diversity permits AGO employees to achieve their fullest potential in an inclusive, respectful environment.
 
One recent measure of the AGO's commitment to diversity can be found in its nomination for Rainbow Alliance and Inclusion Network's "Outstanding Agency Award" in 2019.  Our commitment to employee wellness is reflected in earning the 2024 Zo8 Washington Wellness Award.

APPLICATION INSTRUCTIONS:

In addition to completing the online application, applicants must attach the following documents to their profile in order to be considered for this position:

• A letter of interest, describing your specific qualifications for the position;
• A current resume detailing experience and education.

READ THE FOLLOWING INFORMATION COMPLETELY:

• Carefully review your application for accuracy, spelling and grammar before submitting.
• You may not reapply to this posting for 30 days.
• The initial screening of applications will be solely based on the contents and completeness of the “work experience” and “education” sections of your application in www.careers.wa.gov, completeness of the application material submitted, and responses to the supplemental questionnaire.
• A resume will not substitute for completing the “work experience” section of the application.
• All information may be verified and documentation may be required.

Equal Employment Opportunity and Accommodations Requests

Honoring diversity, equity and inclusion means that as an agency, and as individuals, we are committed to ensuring that all employees and volunteers enjoy a respectful, safe and supportive working environment. Only by fostering the inclusion of people from all backgrounds, cultures and attributes, can AGO employees and volunteers achieve their fullest potential and best advance the goals and mission of the AGO.

The AGO is an equal opportunity employer and does not discriminate on the basis of race, creed, color, national origin, sex, marital status, sexual orientation/gender identity, age, disability, honorably discharged veteran or military status, retaliation or the use of a trained dog guide or service animal by a person with a disability. Persons requiring reasonable accommodation in the application process or requiring information in an alternative format may contact the recruitment team at HREmployment@atg.wa.gov. Those with a hearing impairment in need of accommodation are encouraged to contact the Washington Relay Service at 1-800-676-3777 or www.washingtonrelay.com.

For questions regarding this recruitment or assistance with the application process, please contact the recruitment team at HREmployment@atg.wa.gov.

If you are having technical difficulties creating, accessing or completing your application, please call NEOGOV toll-free at (855) 524-5627 or support@neogov.com.