Author Archives: VWAH

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:

1. 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
2. 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
3. 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:

1. Independent Investigations:
   • Conducts thorough investigations in response to potential fraud, waste, or abuse situations.
2. Data Analysis:
   • Utilizes data analysis techniques to detect aberrancies in Medicare claims data and proactively develops leads from various sources.
3. Referral and Recoupment:
   • Completes written referrals to law enforcement and initiates recoupment of overpaid monies.
4. Coordination:
   • Refers instances of unethical or improper practices to appropriate entities and coordinates with state programs for Medicaid-related issues.
5. Information Sharing:
   • Responds to requests for information from law enforcement and maintains cases referred to them.
6. Fraud Determinations:
   • Makes potential fraud determinations using internal guidelines and relevant regulations.
7. Alerts and Vulnerabilities:
   • Develops and prepares Fraud Alerts and Program Vulnerabilities for submission to CMS.
8. Stakeholder Engagement:
   • Collaborates with Medicare contractors, law enforcement, and other stakeholders, sharing information on ongoing investigations.
9. Administrative Actions:
   • Pursues applicable administrative actions during investigation/case development.
10. Documentation and Reporting:
    • Maintains chain of custody on all documents, follows confidentiality guidelines, and compiles necessary documentation.
11. 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!