Healthcare Fraud Waste Abuse Investigator (Part-time, Remote) at Integrity Management Services

DescriptionResponsibilitiesIdentify and conduct investigations into known or suspected FWA with high autonomyDevelop documentation to substantiate findings including formal reports graphs audit logs and other supporting documentation.Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e. help move identified case types from pay-and-chase to preventive edits and pre-payment activity)Participate in the development and presentation of FWA-related education for assigned CustomersPerform coding reviews for flagged claims to support Coding team (if applicable).RequirementsMinimum of 2 years of experience in healthcare claims analysis auditing payment integrity or a related field.Bachelors degree in Criminal Justice or a related field or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.Knowledge of applicable fraud statutes and regulations and of federal guidelines on recoupments and other anti-FWA activityExperience handling confidential information and following policies rules and regulationsExperience with commercial Medicare or Medicaid claims Strong analytical and problem-solving skills with attention to detail and accuracyExcellent communication skills both written and verbal for effective collaboration with internal teams and external providersProficiency in Microsoft Office particularly Excel and familiarity with claims processing or audit software Certified Fraud Examiner (CFE) Accredited Healthcare Fraud Investigator (AHFI) Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP) or similar is preferredCertified Professional Coder (CPC) or similar is preferred Key Skills Risk Management,Bank Secrecy Act,Fraud,PCI,Law Enforcement,Banking,Business Management,Regulatory Reporting,Analysis Skills,Customer Support,UCC Law,RMF Employment Type : Part-Time Department / Functional Area: Operations Experience: years Vacancy: 1