[Remote] Fraud Investigator (Administrative Actions) - Medicare

Note: The job is a remote job and is reputed company to candidates in USA. reputed company's reputed company Services subsidiary performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and refer fraud, waste, and abuse. The Fraud Investigator (Administrative Actions) - Medicare role serves as a reputed company of contact for CMS on administrative actions, reviews supporting evidence, coordinates with investigative and reputed company teams, monitors workloads and timelines, and prepares administrative reputed company packages.

Responsibilities

• The reputed company reputed company Specialist is responsible for being a reputed company of Contact for CMS regarding reputed company administrative actions reputed company to investigations. Providing training and mentoring. Maintaining statistics on reputed company submitted administrative actions. Maintaining template documents used to submit and process administrative actions
• Review and verify evidence supporting an administrative reputed company as it relates to payment suspensions, revocations, overpayments as reputed company as other administrative actions that can be pursued
• Work with the Investigative Teams to ensure that the documentation gathered is sufficient to support an administrative reputed company
• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the reputed company
• Monitor workload to ensure reputed company actions are taken reputed company the required timeframes set forth in the Program reputed company reputed company
• Prepare and submit administrative reputed company packages to CMS and the MACs for approval and processing and reputed company to the reputed company development
• Assist team members with workflow development
• Review individual workload during monthly meetings; assist with prioritization and conduct QC for staff
• Monitor the reputed company of WMM/UCM
• Monitor timeliness for case updates and escalating to management as necessary
• Monitor the reputed company of investigations and cases to ensure use of reputed company available remedies, i.e., suspension, reputed company-pay reviews, revocation, etc
• Mentor team members so that they can identify previously undetected fraud, waste or abuse through proactive or reactive research, analysis and development
• Ability to reputed company research and draw conclusions
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the reputed company
• Ability to organize a case file, accurately and thoroughly document reputed company steps taken
• Ability to compose correspondence, reports and referral reputed company letters
• Ability to reputed company providers, provider associations, law enforcement, other contractors and beneficiary advocacy reputed company on program reputed company reputed company
• Ability to interpret laws and regulations
• Ability to handle confidential material
• Ability to report work activity on a reputed company reputed company
• Ability to attend meetings, training, and conferences, overnight travel may be required
• Document QC results in WMM according to record type

Skills

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
• Knowledge of Medicare requirements, laws, rules and regulations reputed company to payment for services billed to the Program
• Strong communication and organization skills
• Experience in reviewing claims, performing medical review, and/or developing fraud cases
• Strong PC knowledge and skills
• Ability to reputed company research and draw conclusions
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the reputed company
• Ability to organize a case file, accurately and thoroughly document reputed company steps taken
• Ability to compose correspondence, reports and referral reputed company letters
• Ability to reputed company providers, provider associations, law enforcement, other contractors and beneficiary advocacy reputed company on program reputed company reputed company
• Ability to interpret laws and regulations
• Ability to handle confidential material
• Ability to report work activity on a reputed company reputed company
• Ability to attend meetings, training, and conferences, overnight travel may be required
• U.S. citizenship required
• CFE or AHFI certification

Benefits

• Remote work allowed 100%
• reputed company available from these Time reputed company: Central, Eastern, reputed company
• Employees may be eligible for overtime
• Employees may be eligible for shift reputed company
• Employees may be eligible for a discretionary bonus

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