Health Care Fraud (HCF) Senior InvestigatorAuditor

Birmingham, MI - USA

Monthly Salary: Not Disclosed

Posted on: 1 hour ago

Vacancies: 1 Vacancy

Job Summary

Wits Solutions Inc. (WITS) is a SBA certified Small Disadvantaged Business with headquarters in the metropolitan Washington D.C. area. WITS has been providing best-in-class solutions in professional IT and administrative consulting to various Federal State Local and commercial customers. At WITS we believe in working not for our clients but with them. This is why right from the beginning; our analysts and solution-builders work closely with our clients to ensure that the project outcomes continue to deliver value long into the future.

Job Description:

Security Clearance:

SECRET

Education/ Certification Mandatory:

A Bachelors Degree (Masters preferred) or at least five years of proven experience in investigating healthcare fraud or similar roles
Thorough knowledge of Medicare reimbursement program CPT Codes and common healthcare fraud schemes.

Work Experience Mandatory:

Proficiency in MS Excel MS Outlook MS Word MS PowerPoint and Adobe Acrobat Professional.
Experience with Eclipse Relativity Everlaw and/or Casemap is preferred.
Familiarity with healthcare-specific databases or similar data aggregation tools is a plus.
Proficiency in organizational skills and the ability to multitask assignments;

Work Experience Nice To Have:

Familiarity with healthcare-specific databases or similar data aggregation tools is a plus.

Roles and Responsibilities:

Provides independent leadership of complex healthcare fraud investigations in direct support of the U.S. Attorneys Office managing the full investigative lifecycle from assisting with witness interviews and coordinating the execution of warrants and subpoenas to maintaining comprehensive court-ready documentation.
Provides coordination and collaboration with federal and state agencies both within and outside the USAOs geographical jurisdiction including agencies involved in federal healthcare programs where financial responsibility is implicated in matters involving individual and corporate subjects.
Provides a broad range of ancillary investigative services to the Health Care Fraud Unit including proactive identification and development of high-impact fraud targets using data from Acumen and other databases.
Provides extensive research and analytical support related to suspected civil violations including healthcare fraud and controlled substance offenses through identification collection validation and dissemination of relevant information to law enforcement courts and other entities in consultation with assigned legal staff.
Provides facilitation of district review of qui tam complaints conducts analysis of healthcare billing databases and assesses whether additional investigative resources should be dedicated to specific allegations.
Provides specialized investigative analyses for HCF matters identifies key sources of information and relevant variables and prepares interim and final comprehensive reports for AUSAs supervisory AUSAs and investigative teams including detailed findings conclusions recommendations for further investigative actions and candid assessments of evidentiary strengths and weaknesses.