Search using our robust engine. Get the recommendations you need to get ahead.
Browse through our expansive list of legal practice areas.
Work where you are or where you would like to be. Find where you will work with LawCrossing.
Use our marketplace to feature your opportunity
Start your search today
Set up your account and manage your company profile on LawCrossing
Look through and compare company profiles
Learn from the legal expert
Discover salaries and the scope of your next job
LawCrossing Works Read Testimonials and Share your Story
Do Not Be Influenced by Others’ Negative Opinions of You
In-House
Attorney
Health Care
Min 2 yrs required
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).
Sign Up Now