Healthcare Fraud Waste Abuse Investigator (Full-time, Remote)
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Job Location:
Alexandria, VA - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Department:
Job Summary
Description
Requirements
Responsibilities
- Identify and conduct investigations into known or suspected FWA with high autonomy
- Develop documentation to substantiate findings including formal reports graphs audit logs and other supporting documentation.
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e. help move identified case types from pay-and-chase to preventive edits and pre-payment activity)
- Participate in the development and presentation of FWA-related education for assigned Customers
- Perform coding reviews for flagged claims to support Coding team (if applicable).
Requirements
- Minimum of 2 years of experience in healthcare claims analysis auditing payment integrity or a related field.
- Bachelors degree in Criminal Justice or a related field or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
- Knowledge of applicable fraud statutes and regulations and of federal guidelines on recoupments and other anti-FWA activity
- Experience handling confidential information and following policies rules and regulations
- Experience with commercial Medicare or Medicaid claims
- Strong analytical and problem-solving skills with attention to detail and accuracy
- Excellent communication skills both written and verbal for effective collaboration with internal teams and external providers
- Proficiency in Microsoft Office particularly Excel and familiarity with claims processing or audit software
- Certified Fraud Examiner (CFE) Accredited Healthcare Fraud Investigator (AHFI) Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP) or similar is preferred
- Certified Professional Coder (CPC) or similar is preferred
Key Skills
- Risk Management
- Bank Secrecy Act
- Fraud
- PCI
- Law Enforcement
- Banking
- Business Management
- Regulatory Reporting
- Analysis Skills
- Customer Support
- UCC Law
- RMF
About Company
Integrity Management Services, Inc. (IntegrityM), a Woman Owned Small Business and ISO 900:2008 certified, was founded by the former Inspector General of Health and Human Services, Richard Kusserow. We are experienced and skilled in the establishment, maintenance, auditing, and qualit ... View more
