Key skills
Communication
About this role
Role Overview
- Conduct investigations of allegations of fraudulent and abusive practices
- Coordinate investigation with law enforcement authorities
- Assemble evidence and documentation to support successful adjudication
- Conduct on-site audits of provider records ensuring appropriateness of billing practices
- Prepare complex investigative and audit reports
- Understand department, segment, and organizational strategy and operating objectives
- Make decisions regarding own work methods, occasionally in ambiguous situations
Requirements
- At least 3 years of healthcare fraud investigations and/or auditing experience
- Knowledge of healthcare payment methodologies
- Strong organizational, interpersonal, and communication skills
- Inquisitive nature with ability to analyze data to metrics
- Computer literate (MS, Word, Excel, Access)
- Strong personal and professional ethics.
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance