The Investigator is responsible for identifying, reviewing, analyzing and developing allegations of fraud and abuse in accordance with the regulatory guidelines set forth by CMS. The position will proactively work a caseload for possible referral to external governmental agencies for further investigation/prosecution. This position is responsible for prioritizing the case workloads, researching guidelines, and state and federal laws. The Investigator must remain objective and possess strong analytical skills to assess and determine if fraud and/or abuse is present. This position is also responsible for requesting and analyzing data for case development in a multi-state jurisdiction. The incumbent must develop in-depth knowledge of the different claims processing systems used by the Affiliated Contracts.
*Teleworking options are available for experienced candidates.
Summary of Qualifications
- Bachelor's degree in Accounting, Health Administration, Business, Criminal Justice or related field
- Experience working with various Microsoft Office programs
- Experience in a position presenting information in formal and informal settings
- Experience in a position requiring the ability to manage time and work tasks independently
- Experience in a position interpreting medical regulations and guidelines
- Experience in a position that requires an analytical approach and the ability to make evaluations while following a plan of action
- Experience in accounting is preferred
- Prior healthcare fraud investigations experience is strongly desired
- Previous experience working with the Affordable Care Act (ACA) is preferred
- Bilingual candidates (with fluency in English and Spanish) are preferred
Terms and Agreements
By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
Our Company provides equal employment opportunities to minorities, females, veterans, and disabled individuals, as well as other protected groups.
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CSA protects assets and safeguards against errors to diligently reduce our nations healthcare costs. We specialize in healthcare compliance audits and data analytics incorporating clinical reviews and knowledge of regulatory policies and payment models.
We are headquartered in Birmingham, Alabama with offices located in Iowa, and North Carolina.
CSA is a pioneer in using data analytics to understand complex healthcare data. By anticipating gaps in policy and practices where waste and abuse occurs, our associates combine their professional knowledge with the latest software and analytic tools to create a custom audit solution.
Role: Healthcare Fraud Investigator
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