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Carrot Peelers, Sales, Personality and Your Job Search
In-House
Attorney
Criminal Law - Prosecution
Min 2 yrs required
Fraud and Waste Investigator, Special Investigations Unit The candidate coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. May conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Bachelor's degree is essential. Must have 2+ years of healthcare fraud investigations and auditing experience. Should have knowledge of healthcare payment methodologies. Must have strong organizational, interpersonal, and communication skills. Experience with Laboratory fraud, waste and abuse investigations highly preferred. Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) is essential. Should have understanding of healthcare industry, claims processing and investigative process development. Must have experience in a corporate environment and understanding of business operations. Must be Bilingual (English/Spanish).
Ref: R-215323
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