Temporary Special Investigations Unit Specialist
Lancesoft
- Rancho Cucamonga, CA
- 1 day ago
- $27.34 Per Hour
Highlights
Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred. G., pivot tables, Power Query, conditional formatting, formulas, macros) to organize and analyze referral data, generate reports, and support trend identification.
Numbers & Facts
| Location | Rancho Cucamonga, CA |
| Industry | Staffing/Employment Agencies |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | http://www.lancesoft.com/ |
Description
Title: Temporary Special Investigations Unit Specialist
Duration: Up to 6 Month Assignment
Pay Rate: $27.34/hr on W2
Work location: Rancho Cucamonga, CA 91730
This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)
Key Responsibilities:
Qualifications:
Education & Requirements
Key Qualifications
Duration: Up to 6 Month Assignment
Pay Rate: $27.34/hr on W2
Work location: Rancho Cucamonga, CA 91730
This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)
Key Responsibilities:
- Oversee the intake process for all FWA referrals, conduct preliminary assessments, and determine the urgency and potential impact of each referral to prioritize further actions.
- Triage, manage, and track referrals using the case management and FWA analytics application, ensuring case data integrity throughout the intake process. Utilize advanced Microsoft Excel tools (e.G., pivot tables, Power Query, conditional formatting, formulas, macros) to organize and analyze referral data, generate reports, and support trend identification.
- Conduct preliminary investigations by gathering necessary data, conducting initial analyses, and preparing reports for SIU Investigators. Escalate high-risk or complex issues to appropriate SIU staff or management.
- Collaborate with Compliance Analysts and Investigators to support case triaging and handoff through the FWA analytics and detection application.
- Maintain accurate and comprehensive records of all FWA referrals in SIU s case management system for audit and legal purposes.
- Identify and recommend improvements in intake processes to enhance the efficiency and effectiveness of the SIU.
- Create and maintain standard work specific to workflows and procedures relevant to the role.
- Keep abreast with Federal and State regulatory requirements and respond timely to resolve issues.
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful
Qualifications:
Education & Requirements
- Minimum of three (3) years of experience in a healthcare environment
- Experience preferably in managed care
- Strong preference for experience in fraud investigations or compliance
- High School diploma or GED required
- Associate degree or bachelor s degree from an accredited institution preferred
- Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), or similar certification related to healthcare fraud, coding, and billing is preferred
Key Qualifications
- Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred
- Demonstrated proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.) as tested by CLIENT
- Intermediate to advanced proficiency in Microsoft Excel is required
- Experience with Healthcare Fraud Shield (HCFS) or similar case management platforms is highly desirable
- Knowledge of managed care industry operations, practices, and standards and compliance program practices and elements preferred
- Excellent interpersonal skills. Effective communication skills;verbal and written.
- Strong analytical skills
- Proven ability to work independently and as part of a team in a high-stakes environment
- Ability to manage multiple cases and projects with competing deadlines
- Excellent interpersonal and communication skills, capable of working effectively across various departments and with external partners
- Detail-oriented
- Strong commitment to integrity and ethical decision-making
About Company
We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc).
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.