Nurse Practitioner Investigator – Healthcare Division
The Tennessee Attorney General and Reporter represents all State executives, officials, departments, boards, agencies, and commissions in matters arising from their public duties. Such representation includes participation in litigation, transactional matters, and giving day-to-day legal advice to a wide variety of State entities. The Attorney General's Office employs approximately 200 attorneys organized into 16 legal divisions within 5 sections.
About the Healthcare Division:
The Healthcare Division is part of the State Services and Litigation Section of the Attorney General’s Office. The Division’s Civil Medicaid Fraud (CMF) unit investigates and prosecutes civil cases of Medicaid fraud against healthcare providers and related parties. These efforts serve to deter the submission of false claims to TennCare, Tennessee’s Medicaid program, and restore ill-gotten gains to the State. Most of CMF’s cases result from qui tam actions brought pursuant to the Tennessee Medicaid False Claims Act, as well as referrals from TennCare’s Office of Program Integrity. CMF works on a regular basis with TennCare, the Tennessee Bureau of Investigation, the Tennessee Department of Health, U.S. Department of Justice, the U.S. Attorney’s Offices, and other agencies.
Job Overview:
The CMF team is seeking an organized and detail-oriented nurse practitioner to assist the CMF unit in its investigation of healthcare fraud cases. The nurse practitioner investigator is responsible for analyzing medical records and billing data. The ideal candidate will be adept at working in a collaborative environment with a team comprised of attorneys, investigators, data analysts, and paralegals, to identify and prosecute healthcare fraud. A nurse practitioner investigator on the CMF team regularly performs the following duties, among other tasks as needed:
- Review medical billing claims data and patient records to ensure that the claims are accurate and medically necessary.
- Review patient records to ensure diagnosis information is accurate according to international classification standards.
- Review patient records to identify missing or potentially inaccurate coding.
- Identify and articulate fraudulent billing and documentation trends.
- Compile written reports and summaries of claims data and record review results.
- Work with the attorneys in developing effective case strategies.
- Testify under oath in sworn interviews and court cases.
- Review and organize case documents and records, identifying key documents, analyzing the information, then converting that analysis into usable formats such as spreadsheets, charts and graphs.
- Research relevant Medicaid policies, rules, regulations, and contracts.
- Research relevant medical subjects and appropriate courses of treatment.
The ideal candidate will have the following qualifications:
- Education and active licensure to serve as a nurse practitioner in Tennessee.
- Certification as a medical coding specialist a plus.
- Experience with healthcare-related investigations or direct work experience with healthcare programs.
- Excellent writing ability and experience writing investigative summaries.
- Proficient with technology, including Microsoft Office applications, document review software, and electronic health record platforms.
TO APPLY:
Applications can be submitted via our online applicant portal. Please direct questions to hrteam@ag.tn.gov.
Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State’s policy to provide an environment free of discrimination and harassment of an individual because of that person’s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran’s status, or any other category protected by state and/or federal civil rights laws. Offers for this position will be contingent upon a satisfactory criminal history check.