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SalaryPerform dental hygiene work in researching, investigating, and reviewing records related to Medicaid provider fraud, waste and abuse cases. Determine compliance with Medicaid policies and procedures. Assist Chief Dental Officer with offsite clinical dental examinations. Provide consultative and technical expertise to OIG staff, and other State and Federal agencies and associations as it relates to Medicaid dental providers. Review and provide input on Provider Field Investigations (PFI) policies and procedures for dental cases.
Performs multiple concurrent tasks efficiently and works under minimal supervision with extensive latitude for the use of initiative and independent judgment.
Work involves up to 25% travel; work hours other than 8AM to 5PM. Work involves viewing computer screens for long periods of time.
Performs other duties as assigned and required to maintain division operations.
Performs multiple concurrent tasks efficiently and works under minimal supervision with extensive latitude for the use of initiative and independent judgment.
Work involves up to 25% travel; work hours other than 8AM to 5PM. Work involves viewing computer screens for long periods of time.
Performs other duties as assigned and required to maintain division operations.
Essential Job Functions:
(40%) Research, investigate, and review detailed dental patient records in a timely manner as it relates to Medicaid provider fraud, waste, and abuse cases. Determine compliance with Medicaid policies and procedures. Assist in dental record reviews by facilitating the process from an investigator to the assignment to a dental expert reviewer. Verify that records are adequate and intra-oral images are diagnostic. Organizes all case documents in a logical manner. Maintains tracking information for dental cases.
(25%) Participate in clinical dental examinations including documentation of findings and taking radiographic and photographic oral images under the direction of the Chief Dental Officer. Procures and maintains necessary dental supplies. Ensures dental equipment maintenance contracts are maintained. Performs x-ray equipment testing and radiation safety documentation to ensure compliance with DSHS Radiation Control and Licensing Regulations.
(20%) Provide consultative and technical expertise to OIG staff, and other State and Federal agencies and associations as it relates to Medicaid dental providers. Use professional dental hygiene expertise when providing oral and written communication with the Chief Dental Officer, OIG staff, HHSC staff, and external agencies.
(10%) Interpret and apply applicable agency, state and federal policies, procedures, rules, and regulations as it relates to Medicaid dentistry. Review and provide input on policies and procedures for dental cases.
(5%) Performs other duties as assigned and required to maintain division operations. Keeps supervisor informed as required or as necessary.
(40%) Research, investigate, and review detailed dental patient records in a timely manner as it relates to Medicaid provider fraud, waste, and abuse cases. Determine compliance with Medicaid policies and procedures. Assist in dental record reviews by facilitating the process from an investigator to the assignment to a dental expert reviewer. Verify that records are adequate and intra-oral images are diagnostic. Organizes all case documents in a logical manner. Maintains tracking information for dental cases.
(25%) Participate in clinical dental examinations including documentation of findings and taking radiographic and photographic oral images under the direction of the Chief Dental Officer. Procures and maintains necessary dental supplies. Ensures dental equipment maintenance contracts are maintained. Performs x-ray equipment testing and radiation safety documentation to ensure compliance with DSHS Radiation Control and Licensing Regulations.
(20%) Provide consultative and technical expertise to OIG staff, and other State and Federal agencies and associations as it relates to Medicaid dental providers. Use professional dental hygiene expertise when providing oral and written communication with the Chief Dental Officer, OIG staff, HHSC staff, and external agencies.
(10%) Interpret and apply applicable agency, state and federal policies, procedures, rules, and regulations as it relates to Medicaid dentistry. Review and provide input on policies and procedures for dental cases.
(5%) Performs other duties as assigned and required to maintain division operations. Keeps supervisor informed as required or as necessary.
Knowledge Skills Abilities:
Knowledge of dental diagnoses and procedures, as well as accepted dental treatment patterns and standards of care.
Skill in program evaluation and assessment of health care services.
Ability to apply independent dental hygiene judgment to preliminarily evaluate and assess the appropriate use of dental services.
Ability to apply clinical skills in providing consultation to OIG staff and other agency staff.
Knowledge of Federal and State Medicaid/CHIP program policies and procedures; knowledge of fraud, waste and abuse rules, regulations, statutes, along with the ability to interpret these; and knowledge of legal proceedings.
Knowledge and skills in conducting fraud, waste, and abuse investigations; case review, analysis and evaluation; preparing detailed case documentation; defining problems and making appropriate independent decisions.
Ability to establish and maintain effective working relationships with supervisory personnel, co-workers, providers, attorneys, and individuals from other State and Federal agencies and boards.
Ability to effectively communicate, both orally and in writing and ability to provide consultative advice and/or training. Ability to organize workloads, prioritize tasks and work under time constraints to carry out assigned tasks in a timely manner with minimal supervision.
Ability to travel up to 25% of the time.
Ability to use personal computers and related software: Word, PowerPoint, SharePoint, and Excel required.
Experience with Dentrix or other dental practice management software required.
Experience developing and delivering presentations to audiences of varying size and technical backgrounds preferred.
Knowledge of dental diagnoses and procedures, as well as accepted dental treatment patterns and standards of care.
Skill in program evaluation and assessment of health care services.
Ability to apply independent dental hygiene judgment to preliminarily evaluate and assess the appropriate use of dental services.
Ability to apply clinical skills in providing consultation to OIG staff and other agency staff.
Knowledge of Federal and State Medicaid/CHIP program policies and procedures; knowledge of fraud, waste and abuse rules, regulations, statutes, along with the ability to interpret these; and knowledge of legal proceedings.
Knowledge and skills in conducting fraud, waste, and abuse investigations; case review, analysis and evaluation; preparing detailed case documentation; defining problems and making appropriate independent decisions.
Ability to establish and maintain effective working relationships with supervisory personnel, co-workers, providers, attorneys, and individuals from other State and Federal agencies and boards.
Ability to effectively communicate, both orally and in writing and ability to provide consultative advice and/or training. Ability to organize workloads, prioritize tasks and work under time constraints to carry out assigned tasks in a timely manner with minimal supervision.
Ability to travel up to 25% of the time.
Ability to use personal computers and related software: Word, PowerPoint, SharePoint, and Excel required.
Experience with Dentrix or other dental practice management software required.
Experience developing and delivering presentations to audiences of varying size and technical backgrounds preferred.
Registration or Licensure Requirements:
Licensed by the Texas State Board of Dental Examiners as a Dental Hygienist
Licensed by the Texas State Board of Dental Examiners as a Dental Hygienist
Initial Selection Criteria:
Licensed by the Texas State Board of Dental Examiners as a Dental Hygienist.
At least two years of experience working as a Dental Hygienist.
Proficient experience using Microsoft Office – Word, Excel, and PowerPoint.
Ability to travel up to 25% of the time.
Experience working in a dental managed care environment preferred.
Experience monitoring Medicaid dental services utilization preferred .
Additional Information:
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.
OIG will request that all applicants considered for an interview provide responses to essay questions. Failure to respond to the request could disqualify an applicant from the interview process.
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
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.
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.
OIG will request that all applicants considered for an interview provide responses to essay questions. Failure to respond to the request could disqualify an applicant from the interview process.
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
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:
68E, HM, 890, 4Y0X1
68E, HM, 890, 4Y0X1
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.
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