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Attorney in Waukesha, WI

Humana Inc. Feb 10,2019 Jan 16,2019 Location Waukesha WI
This job is expired...

In-House

Attorney

Min 2 yrs required

Profile

Fraud and Waste Investigator, Commercial Duties : Will conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Qualification and Experience

Requirements : The candidate should have Bachelor's degree. Should have 2+ years of healthcare fraud investigations and auditing experience. History of producing successful outcomes in complex investigations that are often initiated by an ambiguous allegation. Should have knowledge of healthcare payment methodologies. Strong organizational, interpersonal, and communication skills. Must have inquisitive nature with ability to analyze data to metrics. Computer literate (MS, Word, Excel, Access). Strong personal and professional ethics. Preferably should have Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI), understanding of healthcare industry, claims processing and investigative process development and have experience in a corporate environment and understanding of business operations.

Company info