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Health Care Attorney in Doral, FL

Humana Inc. Dec 07,2018 Oct 23,2018 Location Doral FL
This job is expired...

In-House

Attorney

Health Care

Min 2 yrs required

Profile

Fraud and Waste Investigator The candidate conducts investigations of allegations of fraudulent and abusive practices. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Conducts investigations of allegations of fraudulent and abusive practices. Works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach and resources. Collects data and documentation for complex analysis in preparation for investigative interviews and investigative reports. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Establish relationships and collaborate with other internal departments for coordination of investigations. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Qualification and Experience

The candidate should have Bachelor's degree. Must have 2 years of healthcare fraud investigations and auditing experience. Should have knowledge of healthcare payment methodologies. Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) is preferred. Experience working with OIG's, HHS or other investigative healthcare fraud entities is desired. Understanding of healthcare industry, claims processing and investigative process development is preferred. Experience in a corporate environment and understanding of business operations is desired. Must have strong organizational, interpersonal, and communication skills. should be computer literate (MS, Word, Excel, Access).

Company info