Sr. Fraud Investigator (Medicare and Medicaid)
Location: Omaha, Nebraska
Description: Catapult Consultants, LLC is at the momment seeking for Sr. Fraud Investigator (Medicare and Medicaid) right now, this career will be depute in Nebraska. Further informations about this career opportunity please read the description below. Job Description
Catapult Consultants is looking for someone to perform in-depth evaluation of Medicare and Medicaid payments fo! r potential fraud, waste, and abuse investigations, develop investigations that involve monetary losses, sensitive issues, meet criteria for referral to law enforcement, or the imposition of administrative actions. This person will perform other duties and functions as assigned by the Fraud Supervisor, Benefits Integrity Manager, and/or Program Director
Position title upon hire is Senior Benefit Integrity Analyst.
Located in Omaha, NE
A successful candidate will be able to:
Conduct independent investigations resulting from the discovery of situations that potentially involve fraud, waste or abuse in Medicare and Medicaid. Utilize data analysis techniques to detect aberrancies in Medicare and Medicaid claims data, and proactively seek out and develop leads received from a variety of sources (e.g., CMS, OIG, fraud alerts).
Complete written referrals to law enforcement and take steps to recoup overpaid monies.
Review information contained in! standard claims processing system files (e.g., claims history! , provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and Medicaid policies and initiate appropriate action.
Review billing comparisons in Medicaid and Medicare to investigate aberrancies.
Make potential fraud determinations by utilizing a variety of sources such as the Contractors internal guidelines, Medicare and Medicaid provider manuals, Medicare and Medicaid regulations, and the Social Security Act.
Develop and prepare potential Fraud Alerts and Program Vulnerabilities for submission to CMS; share information on current fraud investigations with other Medicare and Medicaid contractors, law enforcement, and other applicable stakeholders.
Review and respond to requests for information from Medicare and Medicaid stakeholders as assigned; pursue applicable administrative actions during investigation/case development (e.g. payment suspensions, civil monetary pen! alties, requests for exclusion, etc.)
Participate in onsite audits in conjunction with investigation development. Provides support of cases at hearing/appeal and Administrative Law Judge level. Maintain chain of custody on all documents and follow all confidentiality and security guidelines.
Compile and maintain various documentation and other reporting requirements. Perform other duties as assigned by Program Director or Benefits Integrity Manager that contribute to Contractor goals and objectives.
Qualifications
At least 3 years of experience in fraud/benefit integrity investigation/detection or a related field that demonstrates expertise in reviewing, analyzing, and developing information, and making appropriate decisions
Knowledge of data analysis techniques required
Ability to use MicroSoft Excel
Knowledge of Medicare and/or Medicaid billing practices preferred
Ability to effectively work independently
B.A. or B.S. degree in a technical fields such as accounting, finan! ce, law enforcement investigation, statistics, data analysis or related field from an accredited U.S. college or university, or equivalent experience.
Additional Information
EEO StatementCatapult Consultants is an Equal Opportunity Employer.
We believe that every employee has the right to work in a dignified work environment free from all forms of discrimination and harassment. Its our policy to recruit, employ, retain, compensate, train, promote, discipline, terminate and otherwise treat all employees and job applicants based solely on qualifications, performance, and competence. This policy reflects our belief that providing equal opportunities for all employees is a both our legal and moral responsibility, and good management practice.
All employees and applicants are treated without regard to age, sex, color, religion, race, national origin, citizenship, veteran status, current or future military status, sexual orientation, gender identifi! cation, marital or familial status, disability or any other status protected by law.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
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If you were eligible to this career, please deliver us your resume, with salary requirements and a resume to Catapult Consultants, LLC.
Interested on this career, just click on the Apply button, you will be redirected to the official website
This career will be started on: Tue, 10 Sep 2013 18:49:38 GMT
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