Healthcare Fraud Investigator

Levels (Investigator, Sr. Investigator, etc) will depend on experience and qualifications.

Integrity Advantage is a small woman owned business serving health payers and other entities challenged with the detection, investigation and prevention of healthcare fraud, waste and abuse (FWA). We are growing and looking for dynamic, confident and skilled individuals who want to grow with us. Our current need is a healthcare FWA investigator to assist our clients in identifying potential allegations of fraud, conducting investigations and assisting in the recovery process. This is a client facing position, so phenomenal customer service skills are key to being hired for this position.

Essential daily duties and responsibilities:

• Perform timely, thorough and well documented investigations

• Maintain, organize and prioritize leads and investigations of varying complexity

• Gather evidence, research and other information to substantiate or refute allegations

• Utilize client’s fraud detection solution to identify post-payment or pre-payment opportunities for investigation as well as other applications to perform data mining or track investigative results

• Support multiple clients with Medicaid, Medicare, Federal Employee and Commercial lines of business

• Communicate status updates to clients as appropriate

• Prepare well written investigative reports including any findings from medical record reviews

• Knowledgeable in using RAT-STATS for statistically valid random sampling

• Ability to provide support to clients for law enforcement referrals, settlement or legal proceedings

• Support other initiatives, as required

Required Education / Licenses / Certifications:

• Bachelor’s degree

• Accredited Healthcare Fraud Investigator (AHFI) preferred

Experience:

• At least 2 years of healthcare claims investigation experience

Knowledge, Skills & Abilities:

• Integrity, accountability and confidence

• Demonstrated ability to create solutions to problems

• Ability to travel for training events, conferences and provide onsite assistance to clients, when needed (appropriate notice will be provided)

• Excellent grasp of MS Word, Excel and PowerPoint

• Quickly adapt to different anti-fraud technology solutions including ad-hoc query, analytical and case management applications

• Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, DRG, and rev codes

• Ability to demonstrate professionalism as well as written and oral communication skills

• Ability to work independently within a remote team, under minimal supervision

Benefits:

• 401(k)

• Dental insurance

• Health insurance

• Paid time off

• Professional development assistance

• Vision insurance

Education:

• Bachelor's Degree

License/Certification:

• AHFI or CFE or industry certification