• Hiring Work at Home Jobs 09.03.2017 Comments Off on Fraud Investigator (Medicare & Medicaid) for Catapult Consultants
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    Fraud Investigator (Medicare & Medicaid) for Catapult Consultants in MN, WI, IL, MI, OH, KY, IA, MO, NE or KS

    Some responsibilities include:

    Job Description

    This position works as an integral member of a multidisciplinary team for a federal government contract to perform investigations to identify fraud, waste and abuse in the billing by Medicare and Medicaid providers. This individual performs in-depth evaluation and analysis of potential fraud cases and requests for information using claims information and other sources of data. This individual supports the development of complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for referral to law enforcement, recoupment of overpayment, and/or administrative action based on reactive and proactive data analysis.

    Full-Time with full benefits
    Work location is an office in:Brookfield, WI; Lisle, IL; Bingham Farms, MI; Grove City, OH; or Omaha, NE. Highly qualified candidates with health care program integrity experience may be approved to work from home in MN, WI, IL, MI, OH, KY, IA, MO, NE or KS.
    Travel may be required 5% to 10% of the time

    Minimum Qualifications:

    High School diploma required
    At least 1 year of experience in program integrity investigation/detection (also known as fraud investigation detection) or a related field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate decisions
    Must have and maintain a valid driver’s license issued by the state of residence
    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
    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 one of the following states: MN, WI, IL, MI, OH, KY, IA, MO, NE or KS
    Certified Fraud Examiner (CFE) certification

    Responsibilities:

    Conducts independent investigations resulting from the discovery of situations that potentially involve fraud, waste, or abuse.
    Utilizes data analysis techniques to detect aberrancies in Medicare claims data, and proactively seeks out and develops leads received from a variety of sources (e.g., CMS, OIG, fraud alerts).
    Completes written referrals to law enforcement and takes steps to initiate recoupment of overpaid monies.
    Refers suspected instances of apparent unethical or improper practices or unprofessional conduct (e.g. quality of care concerns) to the appropriate entity. For Medicaid-related issues, shall coordinate with the State Program Integrity Unity and any other entities at state request within the state responsible for ethical, professional or quality of care issues. For Medicare-related issues, shall coordinate with the Quality Improvement Organization (QIO). For issues involving both programs, shall coordinate across these entities.
    Responds to requests for information from law enforcement. Maintains cases referred to law enforcement.
    Reviews information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare policies and initiates appropriate action.
    Makes potential fraud determinations by utilizing a variety of sources such as the UPIC’s internal guidelines, Medicare and Medicaid provider manuals, Medicare and Medicaid regulations, and the Social Security Act.
    Develops and prepares potential Fraud Alerts and Program Vulnerabilities for submission to CMS; shares information on current fraud investigations with other Medicare contractors, law enforcement, and other applicable stakeholders.
    Reviews and responds to requests for information from Medicare and Medicaid stakeholders as assigned; pursues applicable administrative actions during investigation/case development (e.g., payment suspensions, civil monetary penalties, requests for exclusion, etc.)
    Participates in onsite audits in conjunction with investigation development.
    Provides support of cases at hearing/appeal and ALJ level.
    Maintains chain of custody on all documents and follows all confidentiality and security guidelines.
    Compiles and maintains various documentation and other reporting requirements.
    Performs other duties as assigned by PI Management that contribute to UPIC goals and objectives.

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  • Hiring Work at Home Jobs 21.12.2016 Comments Off on Inside Sales Representative for J. J. Keller & Associates, Inc
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    Inside Sales Representative for J. J. Keller & Associates, Inc in Madison, WI 53705

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    Position Summary

    This is a remote / work-at-home position based out of the Madison / Middleton, WI geographic area.

    Do you want to be rewarded for your selling skills? Are you looking to build loyal customer relationships and grow your career? Our inside sales team might be a perfect fit! You’ll love our diverse portfolio, our commitment to training and the vitality of our more than 505,000 customer relationships. Come be a part of a goal-oriented team that encourages professional development, recognition and rewards.

    As an Inside Sales Representative, your primary focus will be selling our contractual services to existing and prospective customers within the Transportation market utilizing an outbound call approach. This position requires a consultative sales approach with a focus on selling Technology Solutions, Outsourced Services and Consulting: http://www.jjkellerservices.com/index.html

    Apply now. Jobs go fast!

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