Tag Archives: IL

Fraud Investigator (Medicare & Medicaid) for Catapult Consultants

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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


  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!

Case Manager RN for Optum Operations in Lisle, IL

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Case Manager RN for Optum Operations in Lisle, IL

Some responsibilities include:

Primary Responsibilities: Making outbound calls and service inbound calls to assess members’ current health status.

Identifying gaps or barriers in treatment plans and partner with member to develop an effective care plan.

Providing patient education to assist with self-management of their medical condition or disease processes.

Collaborate with Medical Directors on high clinical and financial risk cases Collaborate with Pharmacist regarding medication reconciliation, including lower cost alternatives, medication interactions.

To find out more visit Indeed.com and search for the position title and company. Apply now. Jobs go fast!