Medicare and Medicaid Fraud Investigator at Catapult Consultants
Introduction: Catapult Consultants, a leader in the field of program integrity, is currently seeking a meticulous and experienced Fraud Investigator specializing in Medicare and Medicaid billing. This challenging position involves working collaboratively within a multidisciplinary team to uncover instances of fraud, waste, and abuse in billing by healthcare providers. The individual will play a crucial role in developing complex cases that may involve high financial stakes, sensitive issues, or necessitate referral to law enforcement.
Position Details:
- Location and Schedule:
- Full-time position with comprehensive benefits
- Office locations in Brookfield, WI; Lisle, IL; Bingham Farms, MI; Grove City, OH; or Omaha, NE
- Qualified candidates with health care program integrity experience may be eligible for remote work in specified states
- Qualifications:
- High School diploma required
- Minimum of 1 year of experience in program integrity investigation or a related field
- Valid driver’s license required
- Intermediate knowledge of Microsoft Word, Excel, Outlook, and PowerPoint
- Highly-motivated, detail-oriented professional with excellent analytical, organizational, verbal & written communication, and follow-up skills
- Preferred Qualifications:
- Bachelor’s or Master’s degree in Criminal Justice, Statistics, Data Analysis, Accounting, Finance, Healthcare, or Business-related field
- Certified Fraud Examiner (CFE) certification
- Knowledge of statistics, data analysis techniques, and advanced computer skills
- Experience in fraud detection and investigation within the Medicare program
- Experience working with a Medicaid program in specified states
Responsibilities:
- Independent Investigations:
- Conducts thorough investigations in response to potential fraud, waste, or abuse situations.
- Data Analysis:
- Utilizes data analysis techniques to detect aberrancies in Medicare claims data and proactively develops leads from various sources.
- Referral and Recoupment:
- Completes written referrals to law enforcement and initiates recoupment of overpaid monies.
- Coordination:
- Refers instances of unethical or improper practices to appropriate entities and coordinates with state programs for Medicaid-related issues.
- Information Sharing:
- Responds to requests for information from law enforcement and maintains cases referred to them.
- Fraud Determinations:
- Makes potential fraud determinations using internal guidelines and relevant regulations.
- Alerts and Vulnerabilities:
- Develops and prepares Fraud Alerts and Program Vulnerabilities for submission to CMS.
- Stakeholder Engagement:
- Collaborates with Medicare contractors, law enforcement, and other stakeholders, sharing information on ongoing investigations.
- Administrative Actions:
- Pursues applicable administrative actions during investigation/case development.
- Documentation and Reporting:
- Maintains chain of custody on all documents, follows confidentiality guidelines, and compiles necessary documentation.
- Support and Other Duties:
- Provides support for cases at hearing/appeal and ALJ level and performs additional duties contributing to UPIC goals and objectives as assigned by PI Management.
Catapult Consultants is offering an exciting opportunity for a motivated and skilled individual to contribute to the crucial task of ensuring program integrity in Medicare and Medicaid billing. If you meet the qualifications and seek a challenging yet rewarding role, apply now through Catapult Consultants. Remember, jobs fill quickly!