Fraud Auditor Associate

Overview

This entry-level role supports fraud investigation and auditing activities within a team performing data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

The associate will work under the direct supervision of a team manager and/or team lead and support investigations involving medical professional service providers.

Responsibilities

• Support high-complexity investigations/audits of medical professional service providers and contribute to cases/reports for future action, which may include referral to law enforcement, education, overpayment recovery, and other administrative actions.
• Assist in developing cases/audits and corrective actions by working with internal resources and external agencies.
• Support requests for data and provide investigative/audit support to the team.
• Maintain confidentiality and follow all laws, rules, and regulations concerning health privacy.
• Manage multiple caseload assignments concurrently by organizing and analyzing information to support the team’s workload.
• Research and understand relevant offenses being reviewed and participate in efficient and effective investigations/audits.
• Detect, verify, and document suspected violations by obtaining information and evidence through observation, record examination, and interview.
• Collaborate with team members to analyze investigation/audit results and help determine whether allegations are corroborated and what steps should be taken.
• Assist with the completion of complex reports as required, applying regulations or rules to the affected program(s).
• Prepare correspondence and support clear, objective, accurate communication with others with tact.
• React to unplanned situations as needed; remain flexible in planning activities and adopt effective courses of action.
• Perform essential functions including research, documentation of information, organizing case files, composing correspondence/reports, and reporting work activity on a timely basis.
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
• Interpret laws and regulations as they apply to investigations/audits.
• Attend meetings and training conferences; overnight travel may be required.

Requirements

• 0 years with BS/BA or 4 years with a HS Diploma/equivalent
• Investigative and analytical experience
• Strong communication and organization skills
• Strong PC knowledge and skills
• US. citizenship required

Preferred Qualifications

• Strong background in investigations or compliance audits
• Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments
• Knowledge of investigative or audit practices regarding healthcare providers
• Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies, and procedures
• Background evaluating, reviewing, and analyzing medical claims and records
• Ability to learn and operate a variety of data systems, equipment, and tools used in investigations

Compensation & Benefits

• Target salary range: $39,000 - $62,000
• Salary is determined by scope and responsibilities, experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations.
• Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

Location

• Telework available from Eastern Time Zone

Equal Opportunity

Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.