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 clients 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:
Bachelors 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 other industry certification