Fraud Auditor Associate

Job Description:

• Perform entry-level fraud investigations and audits under direct supervision of a team manager and/or team lead
• Support investigations of medical professional service providers and develop cases and reports for law-enforcement referrals, education, overpayment recovery, and administrative actions
• Work with internal resources, external agencies, state and federal investigators, and other personnel to develop cases, audits, and corrective actions
• Handle multiple caseload assignments concurrently; organize and analyze information
• Assist with complex reports applying regulations or rules to affected programs
• Research relevant offenses and conduct efficient investigations and audits
• Detect or verify suspected violations using observation, record examination, and interviews
• Analyze investigation and audit results to determine whether allegations are corroborated and appropriate corrective steps
• Prepare objective and accurate correspondence
• Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations
• Organize case files and document investigative and audit activities
• Compose correspondence, reports, and referral summary letters
• Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
• Report work activity in a timely manner
• Attend meetings and training conferences; overnight travel may be required

Requirements:

• 0 years with BS/BA or 4 years with a HS Diploma/equivalent
• Investigative and analytical experience
• Strong communication and organization skills
• Strong PC knowledge and skills
• US. citizenship required
• Strong background in investigations or compliance audits (most competitive candidates)
• Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments (most competitive candidates)
• Knowledge of investigative or audit practices regarding healthcare providers (most competitive candidates)
• Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies and procedures (most competitive candidates)
• Background evaluating, reviewing and analyzing medical claims and records (most competitive candidates)
• Ability to learn and operate data systems, equipment and tools used in investigations
• Ability to research and draw conclusions
• Ability to interpret laws and regulations
• Ability to handle confidential material
• Ability to work under direct supervision as a team member
• Ability to attend meetings and training conferences; overnight travel may be required

Benefits:

• Telework available from Eastern Time Zone
• Overtime eligibility may apply
• Shift differential may apply
• Discretionary bonus may apply
• Equal opportunity employment, including disability and protected veterans