State of Maryland

A Medical Payment Investigation Supervisor is the supervisory level of work in the Division of Field Investigations, Medical Care Programs, Maryland Department of Health.  Employees in this classification are primarily responsible for the supervision of a staff of Investigators who conduct investigations of suspected fraud on the part of recipients and/or providers; and may also be assigned to special investigations, such as nursing homes or a specific category of providers.  Employees in this classification conduct investigations that are frequently complex, and may be highly sensitive which requires the essential use of tact, discretion, good judgment and integrity.  Employees in this classification also review cases to be presented to State’s Attorneys, and may be required to testify before Grand Juries and in Circuit Courts. Employees in this classification are responsible for the supervision of lower-level Medical Payments Investigators, support personnel and for preparing required reports and statistical summaries.

Employees in this classification receive general supervision from the Chief, Division of Field Investigation.  Work is evaluated through conferences and review of reports in terms of quality, timeliness and completeness of assigned investigatory activities.

Positions in this classification are evaluated by using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Medical Payments Investigation Supervisor is differentiated from the Medical Payments Investigator III in that the Medical Payments Investigation Supervisor has supervisory responsibility for lower-level Medical Payments Investigators while the Medical Payments Investigator III performs advanced level work by carrying a cases from conception through prosecution with the bare minimum of supervision, and may be responsible for directing other Medical Payments Investigators in major cases.

Exercises supervision and provides field training for investigators who investigate fraud by recipients of Medical Assistance in such areas as false statements on application for assistance and failure to disclose assets or income, or changes in economic status and by providers of Medical Assistance in such areas as overcharging, billing for services not provided, duplicate billing for same services, kickbacks, rebates and other fraudulent practices;

Ensures that reports of completed investigations are such quality that the report when referred to a State’s Attorney can be used to proceed with prosecution or action to recover funds without any additional investigation being necessary;

Oversees the presentation of cases (in a clear, logical concise manner) to Federal and State’s Attorney for prospective opinions;

Trains Medical Payments Investigators in methods of testifying before Grand Juries and in trials;

Maintains records of the work of investigators in their investigations;

Performs other related duties.

Knowledge of modern business methods;

Knowledge of modern interviewing and investigative techniques;

Knowledge of elementary legal processes;

Ability to understand, interpret and explain laws, rules and regulations, procedures and statutory requirements;

Ability to make arithmetic computations with accuracy; to ascertain facts by personal contact and observation;

Ability to select relevant and appropriate information;

Ability to prepare clear and accurate reports;

Ability to deal with the public with tact, understanding, fairness and good judgment;

Ability to maintain confidentiality;

Ability to conduct oneself in a professional manner at all times;

Ability to plan organize, assign and review the work of subordinate investigators;

Ability to train, counsel and evaluate subordinates.

Education:   Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: Five years of full-time experience (or its equivalent) in a combination of the following: claims, credit or administrative investigations; police or licensed private detective work; law enforcement; determination of eligibility for licenses. Two years of this experience must have been in investigations of Medical Assistance frauds.

Notes:

1. Candidates may substitute education at an accredited college or university on a year-for-year basis for up to two years of the required general experience.

2. Candidates may substitute U.S. Armed Forces military service experience as a non-commissioned officer in Law Enforcement or Investigation classifications or Law Enforcement or Investigation specialty codes in the Investigation field of work on a year-for-year basis for the required experience.

1. Employees in this classification may be required to have access to and operate an automobile.   Standard mileage allowance will be paid.

2. Employees in this classification are subject to call-in and, therefore, will be required to provide the employer with a phone number where they can be reached.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions.  Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is not assigned to a bargaining unit, as indicated by the designation of S (Supervisor), M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential).  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.